An Association Between Coronary Artery Calcification Score, C-Reactive Protein, and Antibodies to Infectious Disease in Patients on Maintenance Hemodialysis / 대한신장학회잡지

ABSTRACT

BACKGROUND: Cardiovascular mortality is high in patients with end-stage renal disease (ESRD). Although the factors contributing to ESRD-related vascular disease are incompletely understood, recent studies suggest that inflammatory reaction or chronic infectious disease may play an important role as new risk factors. The aim of present study was to measure coronary artery calcification score (CACs) and to investigate the association with various markers of systemic inflammatory reaction. METHODS: We conducted a cross-sectional study in 33 patients (M F=23 10, age=57+/-2 years) on maintenance hemodialysis. Multirow spiral CT (MSCT) was performed in all patients to measure CACs utilizing area and volume calculations. We measured high sensitivity C-reactive protein (hs- CRP) and interleukin-6 (IL-6) as indicators of inflammatory reaction, and measured IgA and IgG antibodies to C. pneumoniae, and IgG antibodies to H. pylori, cytomegalo virus, and herpes simplex. RESULTS: Median CACs equaled 379 (range, 0- 3, 662) by area and 338 (range, 0-2, 968) by volume. CACs more than 100 was present in 24 (73%) patients. Log (hs-CRP) was positively correlated with log (CACs) (area r=0.37, p<0.05, volume r=0.39, p< 0.05), but log (IL-6) was not. There was no significant relationship between CACs and antibody titers to C. pneumoniae, H. pylori, cytomegalovirus, and herpes simplex. Age was positively correlated with log (CACs) (area r=0.39, p<0.05, volume r=0.39, p< 0.05), but the presence of diabetes, smoking history, the duration of dialysis, body mass index, blood pressure, and serum cholesterol, albumin, PTH, calcium, and phosphorous levels were not. CONCIUSION Coronary artery calcification was common in ESRD patients on hemodialysis, and associated with increased hs-CRP, an indicator of the presence of inflammatory reaction. There was no significant relationship between antibodies to chronic infections such as C. pneumoniae, but large-scale longitudinal studies are needed to evaluate fully that.