Persistent elevation of C-reactive protein may predict cardiac hypertrophy and dysfunction in patients maintained on hemodialysis.

Abstract

BACKGROUND:

C-reactive protein (CRP), which reflects chronic inflammation, is a strong predictor of cardiovascular mortality in hemodialysis patients. We investigated whether persistent elevation of CRP is associated with cardiac function and morphology in patients maintained on hemodialysis.

METHODS:

Predialysis high-sensitivity CRP (hs-CRP) was measured twice at an interval of 3 weeks in 52 stable hemodialysis patients, and echocardiographic studies were performed.

RESULTS:

25 patients showed persistent elevation of predialysis hs-CRP (>3 mg/l, high CRP group). Patients in the high CRP group had a lower dialysis dose (p < 0.01), higher troponin T (p < 0.01), and higher fibrinogen (p < 0.01). Echocardiographic studies showed that left atrial diameter (LA, p < 0.05), interventricular septal thickness (IVST, p < 0.05), left ventricular end-diastolic volume (LVEDV, p < 0.05), and left ventricular mass index (LVMI, p < 0.05) were higher in the high CRP group. However the ejection fraction (EF) was lower in the high CRP group (p < 0.05), which also contained more patients with low EF (<40%) (p < 0.01). There was no difference in diabetes mellitus, acute infection and type of vascular access between the groups. hs-CRP level was positively correlated with troponin T (r = 0.416, p < 0.01) and fibrinogen (r = 0.560, p < 0.001), and IVST with hs-CRP level (r = 0.291, p < 0.05), whereas the EF was negatively correlated with hs-CRP (r = -0.301, p < 0.05). In addition, the high CRP group correlated positively with IVST (r = 0.281, p < 0.05), LVEDV (r = 0.322, p < 0.05), and LVMI (r = 0.312, p < 0.05) and negatively with EF (r = -0.311, p < 0.05). On multivariate analysis, the high CRP group (beta = -0.312, beta = 0.238, and beta = 0.318, respectively) was a significant predictor of EF (R = 0.62, p = 0.025), LVMI (R = 0.928, p = 0.02) and IVST (R = 0.64, p = 0.01).

CONCLUSIONS:

Persistent elevation of CRP, which is an independent risk factor for EF, LVMI and IVST, may predict cardiac hypertrophy and dysfunction in patients maintained on hemodialysis.

• Authors: Byung-Soo Kim, Doo Soo Jeon, Mi Jung Shin, Young Ok Kim, Ho Cheol Song, Seung Hun Lee, Suk Young Kim, Euy Jin Choi, Yoon Sik Chang, Byung Kee Bang
• Journal: American journal of nephrology (Am J Nephrol) 2005 May-Jun Vol. 25 Issue 3 Pg. 189-95 ISSN: 0250-8095 [Print] Switzerland
• PMID: 15863980 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Troponin T
• Fibrinogen
• C-Reactive Protein

Topics

• Adult
• C-Reactive Protein (metabolism)
• Cardiomegaly (diagnostic imaging, etiology)
• Echocardiography
• Female
• Fibrinogen (metabolism)
• Heart Diseases (etiology)
• Heart Septum (diagnostic imaging)
• Humans
• Hypertrophy, Left Ventricular (diagnostic imaging)
• Kidney Failure, Chronic (blood, complications, physiopathology, therapy)
• Male
• Middle Aged
• Predictive Value of Tests
• Renal Dialysis
• Stroke Volume
• Troponin T (blood)