Abstract: OBJECTIVE To understand the clinic feature of the maintenance hemodialysis(MHD) patients with carotid artery atherosclerosis, analyze the relationship between carotid intima-media thickness(CIMT) and serum high sensitive c-reactive protein(HsCRP)， fibroblast growth factor 23(FGF23), Klotho protein levels. METHODS 88 MHD patients were enrolled in the blood purification center, Beijing Hospital of the Ministry of Health, from January to June 2012. The patients were divided into CIMT thickening group and the CIMT normal group based on their carotid color Doppler ultrasound results. FGF23 and Klotho protein were detected by using double antibody sandwich enzyme-linked immunosorbent assay (ELISA). Possible risk factors of CIMT thickening, such as age, gender, duration of dialysis, diabetes, combination therapy, FGF23, Klotho protein, hsCRP, lipids were analyzed and compared between the two groups, while non-conditional logistic regression were used for multivariate analysis to determine the risk factors for CIMT thickening. RESULTS Among the 88 MHD patients, increased CIMT was found in 53 patients（60.2%）, while the remaining 35 patients (39.8%) had normal CIMT. The median of the two sets of CIMT were 1.5mm and 1.0mm respectively, and the difference between the two groups was statistically significant（P=0.000）. The incidence of atherosclerotic plaque in the group with increased CIMT was significantly higher than the group with normal CIMT（92.5% vs.65.7%，P=0.001）. Univariate analysis indicated that the average age of the CIMT thickened group was 66.64±10.61 years, and the average age of the group with normal CIMT was 58.63±11.78 years, the difference was statistically significant（t=3.320，P=0.001）; Diabetes prevalence of the CIMT thickened group was 37.7%, Diabetes prevalence of the group with normal CIMT was 17.1%, the difference was statistically significant（ =4.294，P=0.038）; The median of the two sets of FGF23 were 127.82 ng/L and 86.74 ng/L respectively, the difference was statistically significant（Z=-3.713，P=0.000）; The median of the two sets of HsCRP were 5.34mg/L and 2.19mg/L respectively, the difference was statistically significant（Z=-3.547，P=0.000）; The median of the two sets of Klotho protein were 42.48 U/L and 41.21 U/L respectively, the difference was not statistically significant（Z=-0.085，P=0.932）. Non-conditional logistic regression analysis showed that age, FGF23 and hsCRP were independent risk factors for CIMT thickening in MHD patients, OR values were 1.061 (1.007,1.118), 1.016 (1.003,1.028), 1.344 (1.115,1.621), respectively. CONCLUSION Thickened CIMT are prone to have more atherosclerosis plaque with MHD patients . Serum HsCRP, FGF23 and age are independent risk factors for CIMT thickening in MHD patients.

Key words: Maintenance Hemodialysis, Carotid Intima-media Thickness, High Sensitive C-reactive Protein, Fibroblast Growth Factor 23, Klotho Protein.