Associations of serologic markers of infection and inflammation with vascular disease events and mortality in American dialysis patients.
BACKGROUND
Inflammatory markers predict cardiovascular risk and mortality in endstage renal disease. The relationship of chronic infections to inflammation and vascular disease events has not been reported among American dialysis patients.


METHODS
We performed a cross-sectional and prospective study of a multiracial cohort of 97 chronic hemodialysis patients in California. Anti-Chlamydia pneumoniae IgA and IgG antibodies (Cp-IgA and Cp-IgG), anti-Helicobacter pylori antibodies (Hp-IgG), and highly sensitive C-reactive protein (hsCRP) levels were measured at enrollment. We ascertained the prevalence of atherosclerotic vascular (coronary artery, cerebrovascular, and peripheral vascular) disease (AVD) events, and observed participants for at least 1 year for incident events and mortality. We defined statistical significance as P < 0.01.


RESULTS
Elevated hsCRP levels (77%) and seropositivity to C. pneumoniae were common (Cp-IgA, 49%; Cp-IgG, 64%), whereas the seroprevalence of Hp-IgG was relatively low (25%). The hsCRP levels did not vary with infection status. In bivariate analysis, Cp-IgA and Cp-IgG were each associated with approximately fourfold higher odds of prevalent AVD (P < 0.01). Although anti-chlamydial antibodies maintained nearly significant associations with AVD after covariate adjustment (P < 0.05), antibodies did not predict outcomes over the period of observation. However, hsCRP was a nearly significant independent predictor of prevalent AVD (P = 0.02) and of mortality during follow-up (P = 0.01). We did not detect an association of Hp-IgG with any study outcome.


CONCLUSIONS
Our findings generalize a possible link between C. pneumoniae and prevalent atherosclerosis in American hemodialysis patients and confirm the importance of hsCRP as a prognostic indicator. Our work does not support H. pylori as an important mediator of cardiovascular risk in dialysis patients.
Lentine
Krista L
KL
Saint Louis University Center for Outcomes Research Salus Center, 2nd Floor, 3545 Lafayette Avenue, MO 63104, USA. lentine.krista@stanfordalumni.org
Parsonnet
Julie
J
Taylor
Isabella
I
Wrone
Elizabeth M
EM
Lafayette
Richard A
RA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000276:immunology; D016993:Chlamydophila pneumoniae / Q000276:immunology; D003430:Cross-Sectional Studies; D016480:Helicobacter pylori / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007239:Infections / Q000097:blood / Q000401:mortality; D007249:Inflammation / Q000097:blood / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects; D014481:United States; D014652:Vascular Diseases / Q000097:blood / Q000382:microbiology / Q000401:mortality
D015415:Biomarkers; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D002097:C-Reactive Protein