Increased C-reactive protein following hemodialysis predicts cardiac hypertrophy in chronic hemodialysis patients.
BACKGROUND
Chronic inflammation characterized by increased C-reactive protein (CRP) levels strongly predicts cardiovascular death in both nonrenal and renal patients. We investigated the role of hemodialysis-induced elevated CRP levels on cardiac hypertrophy in hemodialysis patients.


METHODS
We grouped 118 stable patients as responders and nonresponders according to the response of CRP (>4 mg/L) after a single hemodialysis session.


RESULTS
Predialysis CRP and interleukin-6 (IL-6) concentrations were significantly greater in responders compared with nonresponders (6.4 versus 2.0 mg/L and 8.7 versus 4.8 ng/L, respectively; P < 0.01). Postdialysis CRP concentrations in responders (8.8 mg/L; P < 0.05) and IL-6 concentrations in responders and nonresponders (10.0 versus 5.4 ng/L; P < 0.05) further increased. Intact parathyroid hormone, fibrinogen, total cholesterol, low-density lipoprotein cholesterol, and lipoprotein(a) [Lp(a)] levels (P < 0.05), as well as interventricular septal thickness (IVST; P < 0.005), left ventricular posterior wall thickness (LVPWT; P < 0.05), and left ventricular mass index (LVMi; P < 0.05) were significantly greater in responders compared with nonresponders. Predialysis and postdialysis CRP levels correlated positively with Lp(a) (P < 0.01, P < 0,05, respectively), fibrinogen, and predialysis and postdialysis IL-6 levels (P < 0.001) and negatively with albumin level (P < 0.05, P < 0.01, respectively). LVMi, as well as IVST and LVPWT, correlated not only with predialysis and postdialysis CRP levels, but also IL-6 levels (P < 0.05). The interval changes in postdialysis to predialysis CRP levels correlated significantly with IVST, PWT (r = 0.500; r = 0.458; P < 0.001, respectively), and LVMi (r = 0.252; P < 0.05). On multivariate analysis, the responder was the only predictor of IVST, LVPWT, and LVMi (P < 0.001, P < 0.001, and P < 0.01, respectively).


CONCLUSIONS
Elevated CRP concentrations associated with hemodialysis may be useful for the prediction of proatherogenic reactivity and cardiac hypertrophy.
Park
Cheol Whee
CW
Division of Nephrology, Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea, Seoul, Korea.
Shin
Young Shin
YS
Kim
Chul Min
CM
Lee
So Young
SY
Yu
Su Eun
SE
Kim
Suk Young
SY
Choi
Eui Jin
EJ
Chang
Yoon Sik
YS
Bang
Byung Kee
BK
D000740:Anemia / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis / Q000378:metabolism*; D006332:Cardiomegaly / Q000097:blood*; D004452:Echocardiography; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood; D017379:Hypertrophy, Left Ventricular / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D006435:Renal Dialysis / Q000379:methods*; D012307:Risk Factors; D012709:Serum Albumin
D015415:Biomarkers; D015850:Interleukin-6; D012709:Serum Albumin; D002097:C-Reactive Protein