Clinical and Experimental Nephrology

, Volume 10, Issue 1, pp 55–62

Associations of serologic markers of infection and inflammation with vascular disease events and mortality in American dialysis patients

Authors

    • Saint Louis University Center for Outcomes Research Salus Center
    • Division of Nephrology, Department of MedicineSaint Louis University School of Medicine
  • Julie Parsonnet
    • Division of Infectious Diseases and Geographic Medicine, Department of MedicineStanford University School of Medicine
    • Division of Epidemiology, Department of Health Research and PolicyStanford University School of Medicine
  • Isabella Taylor
    • Division of Nephrology, Department of MedicineStanford University School of Medicine
  • Elizabeth M. Wrone
    • Diablo Nephrology Medical Group
  • Richard A. Lafayette
    • Division of Nephrology, Department of MedicineStanford University School of Medicine
ORIGINAL ARTICLE

DOI: 10.1007/s10157-005-0392-5

Cite this article as:
Lentine, K., Parsonnet, J., Taylor, I. et al. Clin Exp Nephrol (2006) 10: 55. doi:10.1007/s10157-005-0392-5

Abstract

Background

Inflammatory markers predict cardiovascular risk and mortality in endstage renal disease. The relationship of chronic infections to inflammation and vascular disease events has not been reported among American dialysis patients.

Methods

We performed a cross-sectional and prospective study of a multiracial cohort of 97 chronic hemodialysis patients in California. Anti-Chlamydia pneumoniae IgA and IgG antibodies (Cp-IgA and Cp-IgG), anti-Helicobacter pylori antibodies (Hp-IgG), and highly sensitive C-reactive protein (hsCRP) levels were measured at enrollment. We ascertained the prevalence of atherosclerotic vascular (coronary artery, cerebrovascular, and peripheral vascular) disease (AVD) events, and observed participants for at least 1 year for incident events and mortality. We defined statistical significance as P < 0.01.

Results

Elevated hsCRP levels (77%) and seropositivity to C. pneumoniae were common (Cp-IgA, 49%; Cp-IgG, 64%), whereas the seroprevalence of Hp-IgG was relatively low (25%). The hsCRP levels did not vary with infection status. In bivariate analysis, Cp-IgA and Cp-IgG were each associated with approximately fourfold higher odds of prevalent AVD (P < 0.01). Although anti-chlamydial antibodies maintained nearly significant associations with AVD after covariate adjustment (P < 0.05), antibodies did not predict outcomes over the period of observation. However, hsCRP was a nearly significant independent predictor of prevalent AVD (P = 0.02) and of mortality during follow-up (P = 0.01). We did not detect an association of Hp-IgG with any study outcome.

Conclusions

Our findings generalize a possible link between C. pneumoniae and prevalent atherosclerosis in American hemodialysis patients and confirm the importance of hsCRP as a prognostic indicator. Our work does not support H. pylori as an important mediator of cardiovascular risk in dialysis patients.

Key words

Cardiovascular diseaseChlamydia pneumoniaeC-reactive proteinHelicobacter pyloriHemodialysisMortality

Copyright information

© Japanese Society of Nephrology 2006