Inflammation as a risk factor for carotid intimal-medial thickening, a measure of subclinical atherosclerosis in haemodialysis patients: the role of chlamydia and cytomegalovirus infection.
OBJECTIVE
Atherosclerotic vascular disease is the most frequent complication seen in haemodialysis (HD) patients. Evidence suggests that inflammation may play a role in the pathogenesis and progression of atherosclerosis. Our aim was to evaluate the causative role of inflammation in atherosclerosis among HD patients.


METHODS
Intima-media thickness (IMT) in carotid arteries was determined in 54 HD patients and 52 controls. Plasma levels of lipids, glucose, albumin and several acute phase proteins, and immunoglobulin G titres against chlamydia and cytomegalovirus were measured in all subjects.


RESULTS
Mean carotid IMT was significantly greater in HD patients than in controls (0.75 mm vs 0.56 mm, P < 0.005). While plasma levels of C-reactive protein (CRP), serum amyloid A (SAA), lipoprotein (a) Lp(a), fibrinogen and ferritin were higher in HD patients, albumin levels were lower. In HD patients, carotid IMT was correlated positively with CRP (R = 0.29, P = 0.019), SAA (R = 0.69, P < 0.001), Lp(a) (R = 0.42, P = 0.001), fibrinogen (R = 0.57, P < 0.001) and chlamydia pneumonia immunoglobulin G titres (R = 0.50, P < 0.001), and negatively with albumin levels (R = -0.33, P = 0.02); there was no relationship between carotid IMT and hypertension, plasma lipid levels and cytomegalovirus. In multivariate regression analysis, these variables still showed a significant relationship with IMT (R(2) = 0.694 and P < 0.001).


CONCLUSIONS
We conclude that atherosclerotic changes are more common in HD patients than in controls, and that inflammatory processes may play a role in the pathogenesis of atherosclerosis.
Buyukhatipoglu
Hakan
H
Division of Nephrology, Faculty of Medicine, Gaziantep University, Turkey. buyukhatip@yahoo.com
Tiryaki
Ozlem
O
Tahta
Kadir
K
Usalan
Celalettin
C
D000209:Acute-Phase Proteins / Q000032:analysis; D000328:Adult; D000682:Amyloid / Q000097:blood; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000473:pathology*; D002097:C-Reactive Protein / Q000032:analysis; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology*; D016022:Case-Control Studies; D002690:Chlamydia Infections / Q000150:complications*; D016993:Chlamydophila pneumoniae; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000150:complications*; D005260:Female; D005293:Ferritins / Q000097:blood; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007249:Inflammation; D017270:Lipoprotein(a) / Q000097:blood; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012307:Risk Factors; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology*; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000473:pathology*; D014463:Ultrasonography
D000209:Acute-Phase Proteins; D000682:Amyloid; D007074:Immunoglobulin G; D017270:Lipoprotein(a); D005340:Fibrinogen; D002097:C-Reactive Protein; D005293:Ferritins