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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Association between Inflammation and Cardiac Geometry in Chronic Kidney Disease: Findings from the CRIC Study
Jayanta Gupta1, Elizabeth A Dominic2, Jeffrey C Fink3
1Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, Texas, United States of America.
Insights
Inflammation markers like high-sensitivity C-Reactive protein (hs-CRP) and interleukin-6 (IL-6) are linked to heart problems in chronic kidney disease (CKD) patients. These findings highlight potential targets for managing cardiac risks in CKD.
Area of Science:
- Nephrology
- Cardiology
- Immunology
Background:
- Left ventricular hypertrophy (LVH) and myocardial contractile dysfunction are significant mortality predictors in chronic kidney disease (CKD).
- The relationship between inflammatory markers and cardiac structure in CKD patients remains understudied, particularly across a broad spectrum of kidney function.
Purpose of the Study:
- To investigate the association between various plasma inflammatory biomarkers and cardiac geometry/function in a large cohort of CKD patients.
- To determine if biomarkers like IL-1β, IL-1RA, IL-6, TNF-α, TGF-β, hs-CRP, fibrinogen, and albumin correlate with LVH, systolic dysfunction, and diastolic dysfunction.
Main Methods:
- Analysis of plasma inflammatory markers and serum albumin in 3,939 participants of the Chronic Renal Insufficiency Cohort study.
- Standardized echocardiography to assess left ventricular hypertrophy, systolic, and diastolic dysfunction, interpreted at a central core laboratory.
Main Results:
- LVH, systolic dysfunction, and diastolic dysfunction were prevalent (52.3%, 11.8%, 76.3%).
- Elevated hs-CRP, IL-1RA, IL-6, and TNF-α were significantly associated with LVH after multivariable adjustment.
- hs-CRP and IL-6 showed significant associations with systolic dysfunction, while hs-CRP also correlated with diastolic dysfunction.
Conclusions:
- In CKD patients, elevated plasma levels of hs-CRP and IL-6 are independently associated with LVH and systolic dysfunction.
- These inflammatory markers may play a role in the cardiac remodeling and dysfunction observed in chronic kidney disease.
Background:
Left ventricular hypertrophy (LVH) and myocardial contractile dysfunction are independent predictors of mortality in patients with chronic kidney disease (CKD). The association between inflammatory biomarkers and cardiac geometry has not yet been studied in a large cohort of CKD patients with a wide range of kidney function.
Methods:
Plasma levels of interleukin (IL)-1β, IL-1 receptor antagonist (IL-1RA), IL-6, tumor necrosis factor (TNF)-α, transforming growth factor (TGF)-β, high-sensitivity C-Reactive protein (hs-CRP), fibrinogen and serum albumin were measured in 3,939 Chronic Renal Insufficiency Cohort study participants. Echocardiography was performed according to the recommendations of the American Society of Echocardiography and interpreted at a centralized core laboratory.
Results:
LVH, systolic dysfunction and diastolic dysfunction were present in 52.3%, 11.8% and 76.3% of the study subjects, respectively. In logistic regression analysis adjusted for age, sex, race/ethnicity, diabetic status, current smoking status, systolic blood pressure, urinary albumin- creatinine ratio and estimated glomerular filtration rate, hs-CRP (OR 1.26 [95% CI 1.16, 1.37], p<0.001), IL-1RA (1.23 [1.13, 1.34], p<0.0001), IL-6 (1.25 [1.14, 1.36], p<0.001) and TNF-α (1.14 [1.04, 1.25], p = 0.004) were associated with LVH. The odds for systolic dysfunction were greater for subjects with elevated levels of hs-CRP (1.32 [1.18, 1.48], p<0.001) and IL-6 (1.34 [1.21, 1.49], p<0.001). Only hs-CRP was associated with diastolic dysfunction (1.14 [1.04, 1.26], p = 0.005).
Conclusion:
In patients with CKD, elevated plasma levels of hs-CRP and IL-6 are associated with LVH and systolic dysfunction.
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