C-Reactive Protein and Anti-Chlamydia Pneumoniae Antibodies as Risk Factors of Cardiovascular Death in Incident Patients on Peritoneal Dialysis

Abstract

Objective Recently it has been pointed out that inflammation and infections caused by germs such as Chlamydia pneumoniae are independent cardiovascular risk factors for the general population, but information about these relationships in dialysis patients is scarce. This work was done to analyze the association of C-reactive protein (CRP) and IgG anti- Chlamydia pneumoniae antibodies (anti-Chlp-IgG) as independent cardiovascular risk factors in incident patients on continuous ambulatory peritoneal dialysis (CAPD). Design Single-cohort, prospective observational study. Setting Three CAPD centers from the Instituto Mexicano del Seguro Social, and one from the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico. Patients A cohort of 75 adult incident patients on CAPD, without clinical signs of congestive heart failure, coronary heart disease, or peripheral arterial insufficiency. No restrictions for age, gender, or cause of renal failure were applied. Primary Outcome Mortality. Methods Demographic variables, body composition by electrical bioimpedance, serum glucose, urea, creatinine, lipids, homocysteine, nutritional markers (albumin, prealbumin, and transferrin), CRP, and anti-Chlp-IgG were measured and registered at the time of the first admission. When a patient died, the cause of death was determined by review of the clinical chart. Results Mean follow-up time was 10.25 patient-months. There were 14 cardiovascular deaths. CRP was positive (> 10 mg/L) in 64% of the patients, and anti-Chlp-IgG in 64%; 29% of the patients were positive for both markers. The relative risk for cardiovascular mortality was 6.23 for patients positive for either CRP or anti-Chlp-IgG, and increased to 9.52 when both markers were positive. Multivariate analysis revealed that CRP and anti-Chlp-IgG were stronger cardiovascular death predictors than age, diabetes, and nutritional status. Conclusion These data suggest that inflammation and the presence of Chlamydia pneumoniae infections are important predictors of cardiovascular death in patients on CAPD.

Cross-over study of influence of oral vitamin C supplementation on inflammatory status in maintenance hemodialysis patients

“…The low level of plasma vitamin C as well as inflammatory status has been recently reported to be closely related to the increased risk of cardiovascular morbidity and mortality in either MHD or peritoneal dialysis (PD) patients [ 6 , 11 ]. Our previous cross-sectional analysis showed that low level of plasma vitamin C is negatively associated with the CRP level [ 12 ].…”

Low levels of vitamin C in dialysis patients is associated with decreased prealbumin and increased C-reactive protein

“…On the other side, antioxidant levels, such as plasma vitamin C level and reduced glutathione level, were usually decreased [ 3 , 5 , 17 , 18 ]. It was documented that inflammation was associated with increased risk of cardiovascular morbidity and mortality in patients on dialysis [ 19 , 20 ].…”

Chronic Kidney Disease and Dialysis in Mexico

“…In other independent studies it was found that more than 80% had C-reactive protein serum levels in the range of positive inflammation, 35% had extracellular fluid volume expansion, and more than 60% were hypertensive (17,18).…”