Soluble adhesion molecules for prediction of cardiac dysfunction in chronic renal failure patients

ABSTRACT

Beside cell-bound adhesion molecules, which are of fundamental importance to a large number of physiological and pathological processes, soluble forms of adhesion molecules have been detected in the circulating blood in recent years. Circulating soluble adhesion molecules appear to be biologically active, and raised levels have been reported in a variety of disorders. In the present study, we measure the serum levels of the soluble [s] molecules included vascular cell adhesion molecule 1 [sVCAM- 1] and sE-selectin in 26 patients on chronic hemodialysis [HD], 16 undialyzed patients with chronic renal failure [CRF], and 10 healthy controls having a similar mean and distribution of ages. The presence of hypoalbuminemia, inflammation [C-reactive protein,CRP] and dyslipidemia were assessed together with echocardiographic evaluation of cardiac dimensions, systolic and diastolic function in all studied groups. sVCAM-1 was found to be elevated in patients with chronic hemodialysis and undialyzed CRF [P < 0.001 each] compared with the controls but levels did not differ between both groups of patients. sE-selectin was also raised in both groups of CRF patients compared with controls [P < 0.001 each] with higher significant level in the undialyzed group [P < 0.05] compared with HD group. Both adhesion molecules are correlated positively to each other [r = 816, P<0.001]. The presence of hypoalbuminemia, inflammation, dyslipidemia together with left ventricular hypertrophy [LVH] and low ratio of E/A peak early LV filling velocity [E] /peak atrial filling velocity [A] by echocardiography were associated with higher sVCAM-1 and sE-selectin than in CRF patients without these findings. Both sVCAM and sE-selectin correlated significantly positive with CRP [P<0.01, P<0.001 respectively], left ventricular mass index [LVMI] [P<0.001, P<0.05 respectively], and significantly negative with high-density lipoprotein [HDL] [P<0.001 each], serum albumin levels [P<0.001 each] and with E/A ratio [P<0.001 each]. Elevated serum concentrations of soluble adhesion molecules [sVCAM-l and sE-selectin] are found in undialyzed and chronic hemodialysis patients who are malnourished inflamed, dyslipidemic and have echo findings of cardiac diastolic dysfunction and LVH