Possible involvement of TNF-á in left ventricular remodeling in hemodialysis patients

Background: Tumor necrosis factor (TNF)-α causes hypertrophic as well as negative inotropic effects on cardiac myocytes. Circulating TNF-α levels are reported to be elevated in end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis (HD). We investigated whether increased circulating TNF-α is associated with left ventricular remodeling against pressure and/or volume overload in HD patients with or without diabetes mellitus. Methods: Echocardiography and the measurement of plasma TNF-α and B-type natriuretic peptide (BNP) concentrations, one of the parameters indicating left ventricular wall stress, were performed on 176 ESRD patients undergoing maintenance HD (88 non-diabetic and 88 diabetic patients). Results: The mean plasma TNF-α concentrations were high, but did not differ between non-diabetic and diabetic patients (9.8 ± 4.3 pg/mL vs. 9.9 ± 5.4 pg/mL). In non-diabetic patients, plasma TNF-α concentration correlated positively with interventricular septal wall thickness (IVST) and relative left ventricular wall thickness (rLVWT), and inversely with left intraventricular dimensions, but did not correlate with left ventricular mass index (LVMI). In contrast, in diabetic patients, plasma TNF-α concentration correlated positively with plasma BNP concentration (r=0.821, p=0.0001) and left intraventricular dimensions, and inversely with rLVWT (r=-0.407, p=0.0001) and left ventricular fractional shortening (r=-0.445, p=0.0001). Conclusions: Circulating TNF-α is possibly involved in concentric left ventricular remodeling in non-diabetic HD patients, whereas it is associated with eccentric left ventricular remodeling against sustained pressure and/or volume overload in diabetic HD patients.