Possible involvement of TNF-alpha in left ventricular remodeling in hemodialysis patients.
BACKGROUND
Tumor necrosis factor (TNF)-alpha causes hypertrophic as well as negative inotropic effects on cardiac myocytes. Circulating TNF-alpha levels are reported to be elevated in end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis (HD). We investigated whether increased circulating TNF-alpha is associated with left ventricular remodeling against pressure and/or volume overload in HD patients with or without diabetes mellitus.


METHODS
Echocardiography and the measurement of plasma TNF-alpha and B-type natriuretic peptide (BNP) concentrations, one of the parameters indicating left ventricular wall stress, were performed on 176 ESRD patients undergoing maintenance HD (88 non-diabetic and 88 diabetic patients).


RESULTS
The mean plasma TNF-alpha concentrations were high, but did not differ between non-diabetic and diabetic patients (9.8 +/- 4.3 pg/mL vs. 9.9 +/- 5.4 pg/mL). In non-diabetic patients, plasma TNF-alpha concentration correlated positively with interventricular septal wall thickness (IVST) and relative left ventricular wall thickness (rLVWT), and inversely with left intraventricular dimensions, but did not correlate with left ventricular mass index (LVMI). In contrast, in diabetic patients, plasma TNF-alpha concentration correlated positively with plasma BNP concentration (r=0.821, p=0.0001) and left intraventricular dimensions, and inversely with rLVWT (r=-0.407, p=0.0001) and left ventricular fractional shortening (r=-0.445, p=0.0001).


CONCLUSIONS
Circulating TNF-alpha is possibly involved in concentric left ventricular remodeling in non-diabetic HD patients, whereas it is associated with eccentric left ventricular remodeling against sustained pressure and/or volume overload in diabetic HD patients.
Nishimura
Masato
M
Cardiovascular Division, Toujinkai Hospital, Kyoto, Japan. tojinkai.hosp@dream.com
Hashimoto
Tetsuya
T
Kobayashi
Hiroyuki
H
Fukukda
Toyofumi
T
Okino
Koji
K
Yamamoto
Noriyuki
N
Nakamura
Naoto
N
Yoshikawa
Toshikazu
T
Takahashi
Hakuo
H
Ono
Toshihiko
T
D003928:Diabetic Nephropathies / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D004452:Echocardiography; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D006435:Renal Dialysis; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis / Q000502:physiology*; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling / Q000502:physiology*
D014409:Tumor Necrosis Factor-alpha; D020097:Natriuretic Peptide, Brain