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Hemodiyaliz Hastalarında Karotis İntima Medya Kalınlığıyla Subklinik Aterosklerozun İlişkisi ve Klamidya ve Sitomegalovirüs İnfeksiyonunun Rolü

Inflammation as a Risk Factor for Carotid Intimal- Medial Thickening, a Measure of Subclinical Atherosclerosis in Hemodialysis Patients and the Role of Chlamydia and Cytomegalovirus Infection

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2006

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Objectives: Atherosclerotic vascular disease (AVD) is the most frequent complication seen in hemodialysis (HD) patients. Eviden¬ ce suggests that inflammation may play a role in the pathogenesis and progression of atherosclerosis. Our a im was to evaluate the causative role of inflammation in atherosclerosis among HD patients. Methods: Intima-media thickness (IMT) in carotid arteries was determined in 54 HD patients and 52 controls. Plasma levels of lipids, glucose, albumin and several acute phase proteins, and IgG titers against Chlamydia and C M V were measured in all subjects. Results: Mean carotid IMT was significantly greater in HD patients than in controls (0.75 mm versus 0.56 mm, p<0.005). Increasing carotid IMT was associated with advancing age in both groups. While plasma levels of CRP, SAA, Lp(a), fibrinogen and ferritin were higher in HD pa¬ tients, albumin levels were lower. In HD patients, carotid IMT was correlated positively with CRP (R=0.29, p=0.019), SAA (R=0.69, p<0.001), Lp(a) (R=0.42, P=0.001), fibrinogen (R=0.57, p<0.001), and with Chlamydia pneumonia IgG titers (R=0.50, p<0.001), and negatively with albu¬ min levels (R=-0.33, p=0.02); there was no relationship between carotid IMT and hypertension, plasma lipid levels, and CMV. Moreover, CRP and SAA were positively correlated with fibrinogen, Lp(a) and Chlamydia, and inversely with albumin levels in HD patients. Conclusions: We conclude that atherosclerotic changes are more common in HD patients than controls, and that inflammatory processes may play a role in the pathogenesis of atherosclerosis. Also, past Chlamydial infection might be more atherogenic than CMV.
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Abstract (Original Language): 
Giriş: Aterosklerotik vasküler hastalık (AVH) hemodiyaliz (HD) hastalarında en sık görülen komplikasyondur. Elde edilen veriler inflamasyonun aterosklerozun patogenezinde ve progresyonunda rol oynadığını düşündürmektedir. Bu çalışmadaki amacımız HD hastalarında aterosklerozun inflamasyon üzerindeki etkisini araştırmaktı. Yöntem: 54 HD hastasında ve 52 kişilik kontrol grubunda intima medya kalınlığı (İMK) ölçüldü. Çalışmaya katılanların tümünde plazma lipid, glukoz, albümin, akut faz proteinleri ve klamidya ve CMV için IgG düzeyleri ölçüldü. Bulgular: Ortalama İMK kontrol grubuna göre anlamlı olarak artmış bulundu (0.75 mm ve 0.56 mm, p<0.005). İki grupta da yaş ile İMK arasında ilişki saptandı. HD hastalarında CRP, SAA, Lp(a), fibrinojen ve ferritin seviyeleri artmış olarak bulunurken, albümin seviyeleri azalmıştı. Hastalarda İMK, CRP (R=0.29, p=0.019), S AA (R=0.69, p<0.001), Lp(a) (R=0.42, P=0.001), fibrinojen (R=0.57, p<0.001), ve klamidya pneumonia IgG seviyeleri (R=0.50, p<0.001) ile pozitif, albümin ile negatif korele idi. Karotis İMK ile; hipertansiyon, plazma lipid seviyeleri ve C M V arasında ilişki saptanmadı. Bu¬ nunla beraber, CRP ve S A A ; fibrinojen, Lp(a) ve klamidya ile pozitif albümin seviyeleri ile negatif korele bulundu. Sonuç: HD hastalarında aterosklerotik değişikliklerin daha fazla olduğu görüldü ve inflamatuar sürecin ateroskleroz patogenezinde rol oynayabileceği sonucuna varıldı. Ayrıca bu çalışma geçirilmiş klamidyal infeksiyonların CMV infeksiyonlarından daha aterojenik olabileceğini düşündürmektedir.
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  • 2
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  • Turkish

REFERENCES

References: 

1. Ma KW, Greene EL, Raij L. Cardiovascular risk factors in chronic renal failure and hemodialysis population. Am J Kidney Dis 1992;19:505-13.
2. Geerlings W, Tufveson G, Ehrich JH, et al. Report on mana¬gement of renal failure in Europe, XXIII. Nephrol Dial Transplant 1994;9(Suppl 1):6-25.
3. Lindner A, Charra B, Sherrard DJ, et al. Accelerated atherosc¬lerosis in prolonged maintenance hemodialysis. N Engl J Med 1974;290:697-701.
4. Kannel WB. CHD risk factors: A Framingham study update.
Hosp Pract 1992;25:93-104.
5. Ross R. The pathogenesis of atherosclerosis: a perspective for
the 1990s. Nature 1993;362:801-9.
6. Grayston JT, Kuo CC, Coulson AT, et al. Chlamydia pneumo¬nia (TWAR) in atherosclerosis of the carotid artery. Circulati¬on 1995;92:3397-4000.
7. Epstein SE, Speir E, Zhou YF, et al. The role of infection in restenosis and atherosclerosis: focus on cytomegalovirus.
Lancet 1996;348(Suppl I):13-7.
8. Pepys MB. The acute phase response and C-reactive protein. In: Weatherall DJ, Ledingham JGG, Warrell DA (Eds), Oxford Textbook of Medicine, 3rd edition, Oxford: Oxford Univer¬sity Press, 1995, pp 1527-33.
9. Liuzo G, Luigi M, Gallimore JG, et al. The prognostic value of C-reactive protein and serum amyloid A protein in severe unstable angina. N Engl J Med 1994;331:417-24.
10. Heinrich J, Shulte H, Schönfeld R, et al. Association of variables of coagulation, fibrinolysis, and acute-phase with atherosclerosis in coronary and peripheral arteries and those arteries supplying the brain. Thromb Haemostas 1995;73:374-8.
11. Hajjar KA, Nachman RL. The role of lipoprotein (a) in athe-rogenesis and thrombosis. Ann Rev Med 1996;47:423-47.
12. Haubitz M, Schulze M, Kock KM. Increase of C-reactive protein serum values following haemodialysis. Nephrol Dial
Transplant 1990;5:500-3.
13. Bergström J, Heimburger O, Lindholm B, et al. Elevated serum C-reactive protein is a strong predictor of increased mortality and low serum albumin in hemodialysis patient. (abstract) J Am Soc Nephrol 1995;6:573-5.
14. Pignoli P, Tremoli E, Poli A, et al. Intimal plus medial thick¬ness of the arterial wall: a direct measurement with ultraso¬und imaging. Circulation 1986;74:1399-406.
15. Ibels LS, Alfrey AC, Huffer WE, et al. Arterial calcification and pathology in uremic patients undergoing dialysis. Am J Med
1979;66:790-6.
16. Kawagishi T, Nishizawa Y, Konishi T, et al. High-resolution B-mode ultrasonography in evaluation of atherosclerosis in
uremia. Kidney Int 1995;48:820-6.
17. London GM, Guerin AP, Marchais SJ, et al. Cardiac and arte¬rial interactions in end-stage renal disease. Kidney Int 1996;
50:600-8.
18. Savage T, Clarke AL, Giles M, et al. Calcified plaque is com¬mon in the carotid and femoral arteries of dialysis patients without clinical vascular disease. Nephrol Dial Transplant
1998;13:2004-12.
19. Vincenti F, Amend WJ, Abele J, et al. The role of hypertensi¬on in hemodialysis-associated atherosclerosis. Am J Med
1980;68:363-9.
20. Salonen R, Seppanen K, Rauramaa R. Prevalence of carotid atherosclerosis and serum cholesterol levels in eastern Fin¬land. Arteriosclerosis 1988;8:788-92.
21. Appel G. Lipid abnormalities in renal disease. Kidney Int 1991;39:169-83.
22. Hahn R, Oette K, Mondorf H, et al. Analysis of cardiovascu¬lar risk factors in chronic hemodialysis patients with special attention to the hyperlipoproteinemia. Atherosclerosis 1983;
48:279-88.
23. Attman P, Alaupovic P. Lipid abnormalities in chronic renal
insufficiency. Kidney Int 1991;39(suppl 31):S16-S23.
24. Berk BC, Weintraub WS, Alexander RW. Elevation of C-reac-
tive protein in "active" coronary artery disease. Am J Cardiol 1990;65:168-72.
25. Docci D, Bilancioni R, Buscaroli A, et al. Elevated serum le¬vels of C-reactive protein in hemodialysis patients. Nephron
1990;56:364-7.
26. McIntyre C, Harper I, Macdougall IC, et al. Serum C-reactive protein as a marker for infection and inflammation in regular
dialysis patients. Clin Nephrol 1997;48:371-4.
27. Wannaer C, Zimmerman J, Quasching T, et al. Inflammation, dyslipidemia and vascular risk factors in hemodialysis pati¬ents. Kidney Int 1997;52(Suppl 62):S553-S5.
28. Zimmermann J, Herrlinger S, Pruy A, et al. Inflammation en¬hances cardiovascular risk and mortality in hemodialysis pa¬tients. Kidney Int 1999;55:648-58.
29. Stenvinkel P, Heimburger O, Paultre F, et al. Strong associati¬on between malnutrition, inflammation and atherosclerosis in
chronic renal failure. Kidney Int 1999;55:1899-911.
30. Ikizler TA, Wingard RL, Harvell J, et al. Association of morbi¬dity with markers of nutrition and inflammation in chronic hemodialysis patients: A prospective study. Kidney Int 1999;
55:1945-51.
31. Loscalzo J. Lipoprotein (a): A unique risk factor for atheroth-rombotic disease. Arteriosclerosis 1990;10:672-9.
32. Maeda S, Abe A, Seishima M, et al. Transient changes of se¬rum lipoprotein (a) as an acute phase protein. Atherosclero¬sis 1989;78:145-50.
92
Türk
Nefroloj
i Diyaliz ve Transplantasyon Dergisi /Official Journal of the Turkish Society of Nephrology
Hemodiyaliz Hastalarında Karotis İntima Medya Kalınlığıyla Subklinik Aterosklerozun İlişkisi 9
33. Zimmermann J, Herrlinger S, Pruy A, et al. Mechanism of high serum lipoprotein (a) in hemodialysis patients. J Am Soc Nephrol 1997;8(abstr):260A.
34. Kandoussi A, Cachera C, Pagniez D, et al. Plasma level of li-poprotein (a) is high in predialysis and hemodialysis, but not
in CAPD. Kidney Int 1992;42:424-5.
35. Cressman MD, Heyka RJ, Paganini EP, et al. Circulating li-poprotein (a) is an independent risk factor for cardiovascular disease in hemodialysis patients. Circulation 1992;86:475-82.
36. Kronenberg F. Lipoprotein (a) in renal disease: What we ha¬ve, what we need, what we can forget. Nephrol Dial Transp¬lant 1995;10:766-9.
37. Ernst E. Fibrinogen: Its emerging role as a cardiovascular risk
factor. Angiology 1994;45:87-93.
38. Koch M, Kutkuhn B, Grabensee B, et al. Apolipoprotein A, fibrinogen, age, and history of stroke are predictors of death in dialyzed diabetic patients: A prospective study in 412 sub¬jects. Nephrol Dial Transplant 1997;12:2603-11.
39. Koch M, Kutkuhn B, Trenkwalder E, et al. Apolipoprotein B, fibrinogen, HDL cholesterol, and apolipoprotein (a) predict
coronary heart disease in hemodialysis patients. J Am Soc
Nephrol 1997;8:1889-98.
40. Libby P, Egan D, Skarlatos S. Role of infectious agents in at¬herosclerosis and restenosis. An assessment of the evidence and need for future research. Circulation 1997;96:4095-103.
41. CREED (Cardiovascular Risk Extended Evaluation in Dialysis Patients) Investigators. C-reactive protein and atherosclerosis in dialysis patients. Nephrol Dial Transplant 1998;13:2710-1.
42. Nieto FJ, Adam E, Sorlie P, et al. Cohort study of cytomega-lovirus infection as a risk factor for carotid intimal-medial thickening, a measure of subclinical atherosclerosis. Circula¬tion 1996;94:922-7.
43. Keane WF, Collins AJ. Influence of co-morbidity on mortality and morbidity of hemodialysis patients. Am J Kidney Dis
1994;24:1010-8.
44. Iseki K, Kawazoe N, Fukiyama K. Serum albumin is a strong predictor of death in chronic dialysis patients. Kidney Int
1993;44:115-9.
45. Kaysen GA, Rathore V, Shearer GC, et al. Mechanisms of hypo-albuminemia in hemodialysis patients. Kidney Int 1995;48:510-6.

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