Chlamydia pneumoniae, overall and cardiovascular mortality in end-stage renal disease (ESRD).
BACKGROUND
Cross-sectional and retrospective studies suggest that Chlamydia pneumoniae infection may contribute importantly to the high cardiovascular risk of patients with end-stage renal disease (ESRD).


METHODS
We investigated the relationship between C. pneumoniae serology and survival and incident fatal cardiovascular events in a cohort of 227 ESRD patients (follow-up of 39 +/- 20 months).


RESULTS
On univariate Cox regression analysis patients with anti-C. pneumoniae immunogloblulin A (IgA) titer > or = 1:16 had a significantly higher risk of all-cause and cardiovascular mortality when compared to patients without IgA antibodies. However, after data adjustment for age and smoking, the hazard ratio (HR) decreased substantially and became largely nonsignificant. Adjustments for traditional and nontraditional risk factors further decreased the independent association of IgA anti-C. pneumoniae and these outcomes (all-cause mortality HR, 1.08; 95% CI, 0.68 to 1.72; P = 0.74; cardiovascular mortality HR, 1.07; 95% CI, 0.60 to 1.89; P = 0.83). A similar loss of prognostic power was observed for IgG anti-C. pneumoniae so that in fully adjusted models the HRs were very close to those observed for IgA anti-C. pneumoniae (all-cause mortality HR, 1.13; 95% CI, 0.68 to 1.86, P = 0.64; cardiovascular mortality HR, 1.10; 95% CI, 0.60 to 2.00; P = 0.77).


CONCLUSIONS
C. pneumoniae seropositivity is associated to shorter survival and incident fatal cardiovascular events in patients with ESRD but these associations are in large part attributable to the link between C. pneumoniae and well-established, traditional risk factors. It is highly unlikely that C. pneumoniae infection is a major risk factor in patients with ESRD.
Zoccali
Carmine
C
National Research Council (CNR), Institute of Biomedicine, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy. carmine.zoccali@tin.it
Mallamaci
Francesca
F
Tripepi
Giovanni
G
Parlongo
Saverio
S
Cutrupi
Sebastiano
S
Benedetto
Frank Antonio
FA
Bonanno
Grazia
G
Seminara
Giuseppe
G
Fatuzzo
Pasquale
P
Rapisarda
Francesco
F
Malatino
Lorenzo Salvatore
LS
D000328:Adult; D000368:Aged; D000907:Antibodies, Bacterial / Q000097:blood; D002318:Cardiovascular Diseases / Q000401:mortality*; D023521:Chlamydophila Infections / Q000401:mortality*; D016993:Chlamydophila pneumoniae / Q000276:immunology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007676:Kidney Failure, Chronic / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis
D000907:Antibodies, Bacterial; D007070:Immunoglobulin A; D007074:Immunoglobulin G