Key result
Persistent elevation of hs-CRP (>3 mg/L) in hemodialysis patients independently predicted lower ejection fraction (P=0.025), higher LV mass index (P=0.02), and increased septal thickness (P=0.01).
Why the study?
Is persistent elevation of hs-CRP associated with cardiac hypertrophy and dysfunction in stable hemodialysis patients?
Observational (n=52)
Is persistent elevation of hs-CRP associated with cardiac hypertrophy and dysfunction in stable hemodialysis patients?
Effect estimate: beta -0.312 (EF), 0.238 (LVMI), 0.318 (IVST)
p-value: p=0.025 for EF, 0.02 for LVMI, 0.01 for IVST
Persistent elevation of CRP is an independent predictor of cardiac hypertrophy and reduced ejection fraction in hemodialysis patients.
Associated with LV hypertrophy and reduced EF in hemodialysis; hypothesis-generating, prospective studies needed before clinical adoption.
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 associated with 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 (beta = -0.312, beta = 0.238, and beta = 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.
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Kim et al. (2005) conducted an observational in Hemodialysis (n=52). Persistent elevation of predialysis hs-CRP (>3 mg/l) vs. No persistent elevation of hs-CRP was evaluated on Ejection fraction (EF), left ventricular mass index (LVMI), and interventricular septal thickness (IVST) (beta -0.312 (EF), 0.238 (LVMI), 0.318 (IVST), p=0.025 for EF, 0.02 for LVMI, 0.01 for IVST). Persistent elevation of hs-CRP (>3 mg/L) in hemodialysis patients independently predicted lower ejection fraction (P=0.025), higher LV mass index (P=0.02), and increased septal thickness (P=0.01).
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