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An association between inflammatory state and left ventricular hypertrophy in hemodialysis patients

Yasemin Erten1, Murat Tulmac, Ulver Derici

  • 1Department of Internal Medicine, Section of Nephrology, Gazi Medical School, 32 Sokak 3/8 Bahcelievler, Ankara, Turkey. yaserten@yahoo.com

Renal Failure
|September 13, 2005
PubMed

Insights

Left ventricular hypertrophy (LVH) in hemodialysis patients is linked to elevated levels of tumor necrosis factor-alpha (TNF-alpha), a key proinflammatory cytokine. Hemodialysis also increases TNF-alpha and IL-6 levels, suggesting a role for inflammation in LVH development.

Area of Science:

  • Nephrology
  • Cardiology
  • Immunology

Background:

  • Left ventricular hypertrophy (LVH) is a common complication in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD).
  • Proinflammatory cytokines are implicated in cardiovascular disease pathogenesis, but their specific role in LVH among HD patients requires further investigation.

Purpose of the Study:

  • To investigate the relationship between LVH and proinflammatory cytokines (IL-1 beta, IL-6, TNF-alpha) in stable HD patients.
  • To assess the impact of the HD procedure itself on the production of these cytokines.

Main Methods:

  • Echocardiographic studies and serum cytokine measurements (IL-1 beta, IL-6, TNF-alpha) were performed in 35 stable HD patients.
  • Potential risk factors for LVH, including blood pressure (BP), HD duration, and various biochemical markers, were evaluated.
  • Cytokine levels pre- and post-HD were compared, and predialysis cytokine levels were compared with those of 12 healthy controls.

Main Results:

  • LVH was present in 57% of HD patients.
  • Left ventricular mass index (LVMI) showed positive correlations with systolic BP, diastolic BP, and serum TNF-alpha levels.
  • Systolic BP and TNF-alpha were identified as independent predictors of LVH.
  • Predialysis IL-6 levels were significantly higher in HD patients than in controls; TNF-alpha levels were also elevated but not significantly.
  • Serum levels of both IL-6 and TNF-alpha significantly increased after the HD procedure.

Conclusions:

  • In addition to blood pressure, proinflammatory cytokines, particularly TNF-alpha, are associated with LVH in ESRD patients on hemodialysis.
  • The hemodialysis procedure itself can lead to an acute increase in the production of key proinflammatory cytokines, potentially exacerbating cardiovascular risk.

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