The prevalence of atherosclerotic
cardiovascular disease in chronic
hemodialysis (HD) patients has been demonstrated to be higher than in healthy people. Severe
liver fibrosis is strongly associated with early
carotid atherosclerosis and it might reduce the survival of patients who undergo both
renal replacement therapy and
transplantation. We wanted to assess whether
nonalcoholic fatty liver disease (
NAFLD) was associated with altered intima-media thickness (IMT) in HD patients as an independent marker of subclinical
atherosclerosis. We enrolled 42 patients undergoing HD and 48 patients with normal renal function, all of them with high levels of
aminotransferases and an ultrasonographic diagnosis of
liver steatosis. The control group consisted of 60 healthy subjects. Laboratory tests for inflammatory and oxidative markers, ultrasonographic liver evaluation, carotid IMT measurement, and liver biopsy were performed. Different degrees of
fibrosis were detected in our study cohort. Worse liver histopathological scores and higher plasmatic levels of
C-reactive protein,
reactive oxygen species, and
vascular cell adhesion molecule-1 were found in HD patients. Carotid IMT was significantly higher (p < 0.005) in patients with histological steatosis. HD patients may develop active and progressive
chronic hepatitis faster than patients with normal renal function and the thickness of their carotid intima-media might be markedly increased. These two conditions seem to be independent on classical risk factors and on
metabolic syndrome. They might be related to the high levels of
oxidants and to the inflammatory state, which are typical of patients undergoing HD. Independently related with the traditional risk factors for cardiovascular disease, nonspecific
inflammation and
oxide-reductive imbalance may play an important role in the progression of
NAFLD and atherosclerotic disease in HD patients.