<p>High sensitivity C-reactive protein as a predictive of intima-media thickness in patients with end-stage renal disease on regular hemodialysis</p>

Abstract

Background Several emerging problems of regular hemodialysis (HD) including cardiovascular complication or atherosclerosis formation caused by chronic inflammation. Intima-media thickness (IMT) of the carotid artery can be applied as a marker of atherosclerosis progression. This study was designed to identify the predictive of IMT progression among end-stage renal disease (ESRD) subject. Methods This cohort study was performed at the Hemodialysis Unit of Dr. Kariadi Hospital and Telogorejo Hospital Semarang between October 2009 and April 2010. The study subjects were the ESRD patients with regular HD. Results This study enrolled 78 subjects with regular HD, follow-up 6 months. The subjects which completed the study were divided into two groups that consist of IMT progressive group (n=53) and IMT non-progressive group (n=12). There were no differences between two groups according to age, gender, history of diabetes, blood pressure, duration of HD, urea, creatinine, blood glucose, HbA1C, cholesterol, triglyceride, HDL, uric acid, phosphate, calcium, homocysteine, and albumin. Subject with high-sensitive C-reactive protein (hsCRP) level >0.52 mg/L had an IMT progression. There was a correlation between hsCRP and the thickening of carotid artery wall after 6-month HD (RR=3.6; 95% CI=2.2–22.9). The subject with hsCRP level >9.00 mg/L after 6-month dialysis progress to thickening of carotid artery wall of >0.03 mm. There was a correlation between hsCRP level (cut-off point: 9.0 m/L) and the progression of the carotid artery wall (RR=2.1; 95% CI=1.3–3.37). Statistically, there was no correlation between IL-6–174 G/C gene and eNOS gene polymorphism with IMT progression. Conclusion hsCRP is a significant predictive of IMT progression at hemodialysis subject. IL −174 G/C gene and eNOS gene polymorphism are not significant predictive of IMT progression at hemodialysis subject.

Long-term Effects of Kidney Transplantation Compared With Dialysis on Intima–media Thickness in Children—Results From the 4C-T Study

“…46 The malnutrition–inflammation–atherosclerosis complex proposes inflammation as a link between malnutrition and CV disease during maintenance dialysis. 47 In contrast to observations made in adults, 31 C-reactive protein as a marker of inflammation did not influence IMT during dialysis in our investigation. Evaluation of other markers for inflammation, like interleukin 6 and tumor necrosis factor-alpha, 47 seems warranted but is not available in our cohort.…”

“…Systolic BP, 14 low-density lipoprotein cholesterol, 27 and body mass index (BMI) 14 are known to broadly impact IMT in health as well as disease and were therefore used in all submodels. Serum phosphorous, 28 bicarbonate, 29 serum albumin, 30 and C-reactive protein 31 were only assessed during dialysis. Kidney function 32 and immunosuppressive medication 33 were only incorporated into the separate models for late and preemptive KTx, whereas time on dialysis (dialysis vintage) was only included for late KTx.…”

The Impact of Medical Nutrition Intervention on the Management of Hyperphosphatemia in Hemodialysis Patients with Stage 5 Chronic Kidney Disease: A Case Series

“…Moreover, various experimental studies highlighted the mechanisms by which phosphate in excess may adversely affect the cardiovascular system [ 21 , 22 ]. Thus, it may directly contribute to vascular damage by pro-inflammatory actions on the vascular smooth muscle cell leading to endothelial dysfunction and promoting vascular calcification [ 23 , 24 ]. Furthermore, a high dietary phosphate content may contribute to atherogenesis [ 25 ] and has also been linked to a more rapid progression of CKD to ESKD [ 19 , 26 , 27 ].…”

Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in evaluation of inflammation in non-dialysis patients with end-stage renal disease (ESRD)

“…Inflammation is involved in the process of end-stage renal disease (ESRD) mainly caused by diabetic nephropathy and chronic glomerulonephritis [1][2][3]. Our previous study and others showed that inflammatory marker is a significant predictor of intima-media thickness (IMT) progression and increased IMT had poor survival in ESRD patients [4][5][6]. It has been reported that increased IMT, as a strong predictor of cardiovascular disease and mortality, was associated with inflammation even in non-dialysis patients [5,7].…”

“…Our previous study and others showed that inflammatory marker is a significant predictor of intima-media thickness (IMT) progression and increased IMT had poor survival in ESRD patients [ 4 – 6 ]. It has been reported that increased IMT, as a strong predictor of cardiovascular disease and mortality, was associated with inflammation even in non-dialysis patients [ 5 , 7 ]. Thus, it is important to pay attention to inflammation in ESRD as well as non-dialysis patients.…”