title: 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.affiliation: Division of Nephrology, Department of Internal Medicine, St. Mary's Hospital, The Catholic University of Korea, Yeouido-dong, Yeongdeungpo-gu, Seoul, Korea.
authors.forename: Byung-Soo
authors.initials: BS
authors.lastname: Kim
authors.forename: Doo Soo
authors.initials: DS
authors.lastname: Jeon
authors.forename: Mi Jung
authors.initials: MJ
authors.lastname: Shin
authors.forename: Young Ok
authors.initials: YO
authors.lastname: Kim
authors.forename: Ho Cheol
authors.initials: HC
authors.lastname: Song
authors.forename: Seung Hun
authors.initials: SH
authors.lastname: Lee
authors.forename: Suk Young
authors.initials: SY
authors.lastname: Kim
authors.forename: Euy Jin
authors.initials: EJ
authors.lastname: Choi
authors.forename: Yoon Sik
authors.initials: YS
authors.lastname: Chang
authors.forename: Byung Kee
authors.initials: BK
authors.lastname: Bang
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism*; D006332:Cardiomegaly / Q000000981:diagnostic imaging / Q000209:etiology*; D004452:Echocardiography; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006331:Heart Diseases / Q000209:etiology*; D006346:Heart Septum / Q000000981:diagnostic imaging; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D013318:Stroke Volume; D020107:Troponin T / Q000097:blood
chemical_list: D020107:Troponin T; D005340:Fibrinogen; D002097:C-Reactive Protein