Comparison of carotid intima-media thickness between hemodialysis and peritoneal dialysis patients

doi:10.5527/wjn.v15.i2.120396

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World Journal of Nephrology

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2220-6124

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Nephrol. Jun 25, 2026; 15(2): 120396
Published online Jun 25, 2026. doi: 10.5527/wjn.v15.i2.120396

Comparison of carotid intima-media thickness between hemodialysis and peritoneal dialysis patients

Nur Samsu, Mala Hayati, Eden Suryoiman Winoto, Hani Susianti

Nur Samsu, Mala Hayati, Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang 65145, Jawa Timur, Indonesia

Eden Suryoiman Winoto, Division of Cardiovascular, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang 65145, Jawa Timur, Indonesia

Hani Susianti, Department of Clinical Pathology, Faculty of Medicine, Universitas Brawijaya, Malang 65145, Jawa Timur, Indonesia

Author contributions: Samsu N conceived and designed the study, performed the data analysis, supervised the study, and drafted the manuscript; Hayati M contributed to data collection, interpretation of the data, and revision of the manuscript; Winoto ES contributed to data collection, interpretation of the data, and revision of the manuscript; Susianti H contributed to data interpretation and critically revised the manuscript for important intellectual content; and all authors approved the final version of the manuscript and agree to be accountable for all aspects of the work.

Supported by Faculty of Medicine, Universitas Brawijaya, No. 7724/6/UN10.F08/PN/2023.

Institutional review board statement: The study was reviewed and approved Health Research Ethics Commission General Hospital Dr. Saiful Anwar Institutional Review Board (Approval No. 400/267/K.3/302/2023).

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The data analyzed in the study are available from the corresponding author on reasonable request.

Corresponding author: Nur Samsu, MD, PhD, Consultant, Lecturer, Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Jalan Veteran, Malang, Malang 65145, Jawa Timur, Indonesia. nur_samsu.fk@ub.ac.id

Received: February 27, 2026
Revised: March 30, 2026
Accepted: April 21, 2026
Published online: June 25, 2026
Processing time: 110 Days and 3 Hours

Abstract

BACKGROUND

Patients with chronic kidney disease (CKD) are at high risk of developing cardiovascular disease (CVD). Carotid intima-media thickness (cIMT) is a strong predictor of CVD. Klotho has been associated with increased atherosclerotic plaque stability in CKD patients.

AIM

To investigate the association between dialysis modality and cIMT in dialysis patients.

METHODS

A cross-sectional study of 83 dialysis patients, 40 hemodialysis (HD) patients and 43 peritoneal dialysis (PD) patients, who met the inclusion criteria. Anamnesis, carotid artery ultrasonography (USG), and laboratory tests were performed on all patients. cIMT measurements were performed in 6 carotid territories using arterial USG.

RESULTS

PD patients had lower cIMT [0.53 (0.47; 0.67) vs 0.63 (0.54; 0.70); P = 0.005]. Younger age in PD patients was independently associated with lower cIMT (β = 0.006; P = 0.003). PD patients had a lower FGF23/Klotho ratio compared to HD patients [26.26 (13.32; 69.45) vs 67.34 (16.56; 131.35); P = 0.039]. Similarly, in PD patients, a moderate positive correlation was found between calcium, phosphorus, and CaxP product levels with fibroblast growth factor 23 (FGF-23) levels. However, the strength of the correlation was reduced when correlated with the FGF-23/Klotho ratio.

CONCLUSION

This study showed that PD patients have lower cIMT than HD patients. Younger age was independently associated with lower cIMT. On the other hand, FGF-23 and the FGF-23/Klotho ratio were significantly positively correlated with CaxP product in PD patients, but not in HD patients. Klotho reduces the strength of this correlation, thus appearing play an important role in the lower cIMT in these PD patients.

Keywords: Calcium; Phosphorus; Carotid artery intima-media thickness; Fibroblast growth factor 23/Klotho ratio; Peritoneal dialysis

Core Tip: Chronic kidney disease patients are at high risk of developing cardiovascular disease (CVD). However, traditional risk factors cannot fully predict the incidence of CVD. Carotid artery intima-media thickness (cIMT) is a strong predictor of CVD. There is evidence of a relationship between dialysis modality and cIMT. In this study, peritoneal dialysis (PD) patients were shown to have lower cIMT than HD, making it a preferred option for patients with end-stage renal disease in the context of CVD risk. This may be due to better preservation of residual kidney function, no exposure to dialysis membranes, and the absence of hemodynamic fluctuations in PD patients.