Persistent Elevation of C-Reactive Protein May Predict Cardiac Hypertrophy and Dysfunction in Patients Maintained on Hemodialysis

Abstract

Background: C-reactive protein (CRP), which reflects chronic inflammation, is a strong predictor of cardiovascular mortality in hemodialysis patients. We investigated whether persistent elevation of CRP is associatedwith cardiac function and morphology in patients maintained on hemodialysis. Methods: Predialysis high-sensitivity CRP (hs-CRP) was measured twice at an interval of 3 weeks in 52 stable hemodialysis patients, and echocardiographic studies were performed. Results: 25 patients showed persistent elevation of predialysis hs-CRP (>3 mg/l, high CRP group). Patients in the high CRP group had a lower dialysis dose (p < 0.01), higher troponin T (p < 0.01), and higher fibrinogen (p < 0.01). Echocardiographic studies showed that left atrial diameter (LA, p < 0.05), interventricular septal thickness (IVST, p < 0.05), left ventricular end-diastolic volume (LVEDV, p < 0.05), and left ventricular mass index (LVMI, p < 0.05) were higher in the high CRP group. However the ejection fraction (EF) was lower in the high CRP group (p < 0.05), which also contained more patients with low EF (<40%) (p < 0.01). There was no difference in diabetes mellitus, acute infection and type of vascular access between the groups. hs-CRP level was positively correlated with troponin T (r = 0.416, p < 0.01) and fibrinogen (r = 0.560, p < 0.001), and IVST with hs-CRP level (r = 0.291, p < 0.05), whereas the EF was negatively correlated with hs-CRP(r = –0.301, p < 0.05). In addition, the high CRP group correlated positively with IVST (r = 0.281, p < 0.05), LVEDV (r = 0.322, p < 0.05), and LVMI (r = 0.312, p < 0.05) and negatively with EF (r = –0.311, p < 0.05). On multivariate analysis, the high CRP group (β = –0.312, β = 0.238, and β = 0.318, respectively) was a significant predictor of EF (R = 0.62, p = 0.025), LVMI (R = 0.928, p = 0.02) and IVST (R = 0.64, p = 0.01). Conclusions: Persistent elevation of CRP, which is an independent risk factor for EF, LVMI and IVST, may predict cardiac hypertrophy and dysfunction in patients maintained on hemodialysis.

C-Reactive Protein, Left Ventricular Mass Index, and Risk of Cardiovascular Disease in Essential Hypertension

“…The present observation of an independent association between categories of CRP level and LVMI is consistent with previous findings (15,19), and the present study extended these observations for CRP to essential hypertension. A raised baseline CRP value has been associated with inflammation, endothelial dysfunction (14), obesity (14), the metabolic syndrome (30,31), diabetes mellitus (32), insulin resistance (13), and severity of hypertension (33), and thus, various metabolic disorders may occur with increasing CRP level, and simultaneously promote an increase in LV mass.…”

Significant Correlation between Ankle-Brachial Index and Vascular Access Failure in Hemodialysis Patients

“…In ESRD patients, chronic inflammation, as expressed by increased CRP levels, has been identified as accelerating atherosclerosis (39). Data from several studies have demonstrated that elevated levels of the acute-phase reactant CRP were associated with increased cardiovascular events and atherosclerosis (decreased ABI) (40,41). In the present study, there was no correlation between high-sensitivity CRP and ABI Ͻ0.9 or vascular access failure.…”

Adiponectin and Cardiovascular Remodeling in End-Stage Renal Disease and Co-Morbid Diabetes Mellitus

“…Elevated hs-CRP levels have been reported as being a strong predictor of cardiovascular mortality and atherosclerosis in ESRD patients [5, 6]. Also, hs-CRP levels correlate with the length of dialysis in ESRD patients alluding to a strong involvement of the protein in the inflammatory process [7].…”

“…Also, hs-CRP levels correlate with the length of dialysis in ESRD patients alluding to a strong involvement of the protein in the inflammatory process [7]. This is important given recent reports linking altered hs-CRP levels with cardiac hypertrophy and increased arterial stiffness [5, 6, 8]. Ample evidence also exists to support a direct role of hs-CRP in inflammatory cell recruitment and endothelial dysfunction by upregulating endothelial cell adhesion molecules [9].…”