Systemic inflammation is associated with pulmonary hypertension in patients undergoing haemodialysis.
BACKGROUND
Pulmonary hypertension (PH) is an overlooked cardiovascular morbidity in patients undergoing haemodialysis. Inflammation has been demonstrated to play a significant role with certain types of PH in non-uraemic patients, but studies analysing the mechanisms in dialyzed patients with PH are rare. Hence, we investigated systemic and local inflammation biomarkers associated with PH in uraemia patients to elucidate the potential mechanism.


METHODS
A cross-sectional study was conducted in which 97 haemodialysis patients were initially evaluated in our hospital. Twelve inflammatory cytokines were measured using a cytometric beads assay in patients with and without PH. FE(NO) (fractional exhaled nitric oxide) was checked by a chemiluminescence analyser in patients with and without PH as well as by normal controls.


RESULTS
Thirty-nine eligible patients were enrolled. Compared to patients without PH (group A), patients with PH (group B) had significantly higher serum levels of hs-CRP, IL-1beta, TNF-alpha and IL-6. FE(NO) was also measured. Though the pre-dialysis FE(NO) levels were elevated in both groups; group B patients had significantly higher pre-dialysis FE(NO) levels than group A patients (39.9 +/- 16.7 versus 31.8 +/- 10.3, P = 0.045). The post-dialysis FE(NO) levels returned to normal in group A while the remaining were significantly higher in group B (30.3 +/- 10.3 versus 20.1 +/- 10.9, P = 0.003).


CONCLUSIONS
Our study revealed that dialyzed patients with PH had a significantly higher level of airway FE(NO) as well as serum levels of acute phase reactive protein and cytokines, including IL-1beta, TNF-alpha and IL-6. A chronic inflammation might play an important role in the pathogenesis of PH in patients undergoing haemodialysis.
Yu
Tung-Min
TM
Division of Nephrology, Department of Internal Medicine,Taichung Veterans General Hospital, Taiwan.
Chen
Yi-Hsing
YH
Hsu
Jeng-Yuan
JY
Sun
Chung-Shu
CS
Chuang
Ya-Wen
YW
Chen
Cheng-Hsu
CH
Wu
Ming-Ju
MJ
Cheng
Chi-Hung
CH
Shu
Kuo-Hsiung
KH
D001166:Arteriovenous Shunt, Surgical; D001783:Blood Flow Velocity; D002097:C-Reactive Protein / Q000378:metabolism; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood / Q000209:etiology*; D007249:Inflammation / Q000097:blood / Q000209:etiology*; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D014511:Uremia / Q000097:blood / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*
D016207:Cytokines; D018836:Inflammation Mediators; D002097:C-Reactive Protein