Inflammation, arteriosclerosis, and cardiovascular therapy in hemodialysis patients.
BACKGROUND
Aortic stiffness and left ventricular hypertrophy (LVH) are predictors of mortality in hemodialysis (HD) patients. Attenuation of arterial stiffness and regression of LVH had a favorable effect on survival in these patients, but this favorable effect was observed in less than 50% of patients, the rest being resistant to therapeutical interventions. The aim of this study was to analyze the factors associated with this resistance to treatment.


METHODS
138 patients on HD were studied during a follow-up survey. From entry until the end of follow up, the changes of aortic pulse wave velocity (PWV) and of LV mass were measured in response to treatment with antihypertensive drugs and erythropoietin, together with measurements of blood chemistry, including high-sensitive C-reactive protein (CRP). Patients with decreased aortic PWV were considered to be responders (N = 68), the others to be nonresponders (N = 70).


RESULTS
Nonresponders were older (P < 0.05) and had persistently higher systolic blood pressure (BP) and pulse pressure. Responders were treated more frequently with an ACE inhibitor (P < 0.001), and had lower serum CRP (P < 0.01). The baseline PWV, as well as the changes of PWV and LV mass during the follow-up were significantly and independently correlated with serum CRP level (P < 0.001). According to logistic regression after adjustment for age, gender, diabetes, history of CVD, and the nonspecific cardiovascular risk factors, the improvement of aortic stiffness and LV hypertrophy was positively associated with prescription of ACE inhibitor (P < 0.0001), and negatively with the serum CRP level (P < 0.01).


CONCLUSIONS
These results indicate that in HD patients, the presence of low-grade inflammation decreases the efficiency of cardiovascular therapeutic interventions and participates in the persistence of cardiovascular hemodynamic overload.
London
Gérard M
GM
Hopital F.H. Manhès, Fleury-Mérogis, Cedex, France. glondon@club-intenet.fr
Marchais
Sylvain J
SJ
Guerin
Alain P
AP
Metivier
Fabien
F
Adda
Hassan
H
Pannier
Bruno
B
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001018:Aortic Diseases / Q000150:complications / Q000276:immunology / Q000473:pathology; D001161:Arteriosclerosis / Q000150:complications / Q000276:immunology*; D001262:Atenolol / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000276:immunology*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009568:Nitrendipine / Q000627:therapeutic use; D012044:Regression Analysis; D006435:Renal Dialysis; D014657:Vasculitis / Q000150:complications / Q000276:immunology
D000959:Antihypertensive Agents; D001262:Atenolol; D002097:C-Reactive Protein; D009568:Nitrendipine