IL-6 Versus TNF-α as Predictors of Echocardiographic Cardiac Remodeling in Maintenance Hemodialysis Patients
Alexandru Florin Sircuța1,2,3, Iulia Dana Grosu1,2,3, Adalbert Schiller1,2
1Department of Internal Medicine II-Nephrology University Clinic, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania.
Insights
Interleukin-6 (IL-6) is linked to cardiac remodeling in hemodialysis patients. This cytokine showed stronger associations with echocardiographic changes than Tumor Necrosis Factor-alpha (TNF-α), suggesting its potential as a biomarker.
Area of Science:
- Nephrology
- Cardiology
- Immunology
Background:
- Cardiovascular disease is a major cause of mortality in end-stage renal disease patients.
- Systemic inflammation, particularly involving cytokines like IL-6 and TNF-α, is implicated in myocardial remodeling in this population.
- Understanding these inflammatory markers' associations with cardiac structure and function is crucial for risk stratification.
Purpose of the Study:
- To investigate the relationship between serum levels of Interleukin-6 (IL-6), Tumor Necrosis Factor-alpha (TNF-α), and Interleukin-1 beta (IL-1β) and echocardiographic parameters of cardiac remodeling.
- To assess these associations in patients undergoing maintenance hemodialysis.
- To identify potential inflammatory biomarkers predictive of subclinical cardiac changes.
Main Methods:
- A single-center retrospective observational study involving 58 maintenance hemodialysis patients.
- Measurement of pre-dialysis serum cytokines (IL-6, TNF-α, IL-1β) and laboratory markers (CRP, albumin, hemoglobin).
- Echocardiography was performed to assess left ventricular mass (LVM), global longitudinal strain (GLS), interventricular septum (IVS), left ventricular end-diastolic diameter (LVEDD), and right ventricular diameter (RVD).
- Statistical analysis included Spearman correlations and multivariate linear regression.
Main Results:
- Interleukin-6 (IL-6) positively correlated with left ventricular mass (LVM), right ventricular diameter (RVD), and C-reactive protein (CRP).
- Tumor Necrosis Factor-alpha (TNF-α) showed an inverse correlation with LVM.
- Multivariate analysis indicated that LVM and RVD independently predicted IL-6 levels, while age, CRP, and albumin predicted TNF-α levels.
Conclusions:
- Interleukin-6 (IL-6) demonstrated stronger associations with echocardiographic indicators of cardiac hypertrophy and dilation compared to TNF-α in hemodialysis patients.
- These findings support IL-6's potential role as a biomarker for subclinical cardiac remodeling in patients with end-stage renal disease on maintenance hemodialysis.
- Further investigation into IL-6 as a predictive marker for cardiovascular complications in this high-risk group is warranted.
Abstract:
Background and Objectives: Cardiovascular disease remains the leading cause of mortality in end-stage renal disease, with systemic inflammation implicated in myocardial remodeling. We aimed to assess the associations between IL-6, TNF-α, and IL-1β and echocardiographic parameters of cardiac remodeling, including left ventricular mass (LVM), global longitudinal strain (GLS), interventricular septum (IVS), left ventricular end-diastolic diameter (LVEDD), and right ventricular diameter (RVD), in patients undergoing maintenance hemodialysis. This was a single-center retrospective observational study. Materials and Methods: In 58 maintenance hemodialysis patients (mean age 60.4 ± 11.7 years; 55% male), pre-dialysis serum cytokines (IL-6, TNF-α, IL-1β) and standard laboratory markers (C-reactive protein [CRP], albumin, hemoglobin) were measured. Echocardiography was performed under clinically stable conditions. Spearman correlations assessed relationships between cytokines and imaging parameters; multivariate linear regression identified independent predictors. Results: Median IL-6 was 7.36 pg/mL (interquartile range [IQR] 4.52-11.03), and median TNF-α was 9.35 pg/mL (IQR 7.9-12.57). IL-6 correlated positively with LVM (ρ = 0.63, p < 0.001), RVD (ρ = 0.53, p < 0.001), and CRP (ρ = 0.52, p < 0.001). In contrast, TNF-α inversely correlated with LVM (ρ = -0.36, p = 0.006). Multivariate regression showed IL-6 was independently predicted by LVM (p = 0.019) and RVD (p = 0.042), while TNF-α was predicted by age (p < 0.001), CRP (p = 0.038), and albumin (p = 0.012). Conclusions: In hemodialysis patients, IL-6 showed stronger associations with echocardiographic hypertrophy and dilation than TNF-α, supporting its role as a potential biomarker of subclinical cardiac remodeling.IL-6 showed stronger correlations with echocardiographic remodeling markers compared with TNF-α and may warrant further investigation as a potential biomarker in this setting.
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