Inflammation, Endothelial Dysfunction and Increased Left Ventricular Mass in Chronic Kidney Disease (CKD) Patients: A Longitudinal Study

<div><p>Introduction</p><p>Within this longitudinal study we investigated the association of inflammation markers C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNFα) and endothelial dysfunction markers intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) with left ventricular mass indexed for height²·⁷¹ (LVMI) in hypertensive predialysis CKD patients.</p><p>Material and Methods</p><p>From 2004 to 2005, 182 incident consecutive adult patients from the outpatient CKD clinics of two hospitals in Greece with CKD and hypertension or using antihypertensive medication, were included. Of these, 107 patients underwent CRP (mg/l) and LVMI (g/height²·⁷¹) measurements annually for three years.</p><p>Results</p><p>In the longitudinal analyses, using linear mixed modeling, a higher IL-6 (ß = 1.9 (95%ci:0.38;3.5), inflammation score based on CRP, IL-6 and TNF-α (ß = 5.0 (95%ci:0.72; 9.4) and VCAM-1 (ß = 0.01 (95%ci:0.005;0.02) were associated with higher LVMI. These models were adjusted for age, gender and primary renal disease, and for confounders that on top changed the beta with ≥10%, i.e. diuretic use (for IL-6 and inflammation score).</p><p>Conclusion</p><p>The results suggest that in predialysis CKD patients, inflammation as well as endothelial dysfunction may play an important role towards the increase in LVMI.</p></div

The association between both inflammation markers and endothelial dysfunction markers with left ventricular mass using linear regression analysis in cross sectional data.

<p>The association between both inflammation markers and endothelial dysfunction markers with left ventricular mass using linear regression analysis in cross sectional data.</p

Correlation between log TNF-α with left ventricular mass (g/m²·⁷¹) (n = 182).

<p>Correlation between log TNF-α with left ventricular mass (g/m²·⁷¹) (n = 182).</p

The association between inflammation markers and endothelial dysfunction markers and left ventricular mass per year using linear mixed modelling in longitudinal data.

<p>The association between inflammation markers and endothelial dysfunction markers and left ventricular mass per year using linear mixed modelling in longitudinal data.</p

Correlation between IL-6 with left ventricular mass (g/m²·⁷¹) (n = 182).

<p>Correlation between IL-6 with left ventricular mass (g/m²·⁷¹) (n = 182).</p

Correlation between VCAM-1 with left ventricular mass (g/m²·⁷¹) (n = 182).

<p>Correlation between VCAM-1 with left ventricular mass (g/m²·⁷¹) (n = 182).</p

Likelihood of a physician referral to a nephrologist by renal diagnosis.

<p>Likelihood of a physician referral to a nephrologist by renal diagnosis.</p

Specialty of physicians referring patients to Greek National Health System Outpatient Nephrology Clinics.

<p>The number of patients (N = 948) in this table differs from the total number of patients in the study (N = 1501), because N = 1501–948 = 553 patients were self-referrals. Data are given as n(%).</p><p>Specialty of physicians referring patients to Greek National Health System Outpatient Nephrology Clinics.</p

Patient characteristics.

<p>Data are given as Mean ±SD or n (%) unless stated otherwise.</p><p>Patient characteristics.</p

Distribution of stages of CKD in PRESTAR according to different estimating equations, CKD-Epi, MDRD, Cockroft Gault (CG), CG normalized to Body Surface Area (CGBSA).

<p>Distribution of stages of CKD in PRESTAR according to different estimating equations, CKD-Epi, MDRD, Cockroft Gault (CG), CG normalized to Body Surface Area (CGBSA).</p