Study on evaluation of the persistent elevation of C-reactive protein as a predictor of cardiac hypertrophy and dysfunction in elderly patients maintained on hemodialysis

ABSTRACT

The average age of dialysis patients is increasing each year, reflecting the aging of the population in general. Hemodialysis [HD] patients suffer from a chronic inflammation. They are at increased risk of cardiovascular disease. To evaluate the persistent elevation of C reactive protein [CRP] as a predictor of cardiac hypertrophy and dysfunction in elderly patients maintained on HD. Quantitative determinations of serum high-sensitivity C reactive protein [hs-CRP] by ELISA were done in the 3 studied groups; Group A included 30 selected end stage renal disease [ESRD] elderly patients maintained on regular HD at the Main Alexandria University Hospitals. Their mean ages were 68.50 +/- 5.20 years [15 males and 15 females]. Group B included 20 age-matched elderly healthy individuals. Their mean ages were 69.10 +/- 6.42 years [10 males and 10 females]. Group C included 10 healthy adult individuals. Their mean ages were 34.20 +/- 4.85 years [5 males and 5females]. Doppler Echocardiography was done to all subjects with estimation of ejection fraction [EF%], fractional shortening [FS%], and left ventricular mass index [LVMi] as well as E/A and El/Al ratios. In elderly HD patients, hs-CRP showed statistically significant higher levels than those of groups B and C with significantly higher values in group B than group C [F=19.85, p=0.001]. By using echocardiography, LVMi showed statistically significant higher values in group A than the other 2 groups with no significant difference between them [F=0.854, p=0.01], whereas FS and EF percentages showed no significant differences between the 3 studied groups. Both E/A and El/Al ratios showed statistically significant lower values in group A than groups B and C [x[2]= 13.33 and 12.38, p= 0.00] and 0.02 respectively]. Correlation study showed a significant negative correlation between serum hs-CRP levels and serum albumin, EF% and E/A ratio. On the other hand, serum hs-CRP levels had a significant positive correlation with serum urea, erythrocyte sedimentation rate [ESR] and LVMi. In elderly patients maintained on HD, the persistent elevation of CRP, which reflects chronic inflammation, had a high impact on the occurrence of left ventricular hypertrophy [LVH] and dysfunction. These data lend support to the hypothesis that inflammation plays an important role in the pathogenesis of cardiovascular diseases in these patients