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Inflammation is an amplifier of lung congestion by high lv filling pressure in hemodialysis patients: a longitudinal study

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Abstract

Introduction

Since inflammation alters vascular permeability, including vascular permeability in the lung, we hypothesized that it can be an amplifier of lung congestion in a category of patients at high risk for pulmonary oedema like end stage kidney disease (ESKD) patients.

Objective and methods

We investigated the effect modification by systemic inflammation (serum CRP) on the relationship between a surrogate of the filling pressure of the LV [left atrial volume indexed to the body surface area (LAVI)] and lung water in a series of 220 ESKD patients. Lung water was quantified by the number of ultrasound B lines (US-B) on lung US. Six-hundred and three recordings were performed during a 2-year follow up. Longitudinal data analysis was made by the Mixed Linear Model.

Results

At baseline, 88 had absent, 101 had mild to moderate lung congestion and 31 severe congestion. The number of US B lines associated with LAVI (r = 0.23, P < 0.001) and serum CRP was a robust modifier of this relationship (P < 0.001). Similarly, in fully adjusted longitudinal analyses US-B lines associated with simultaneous estimates of LAVI (P = 0.002) and again CRP was a strong modifier of this relationship in adjusted analyses (P ≤ 0.01). Overall, at comparable LAVI levels, lung congestion was more pronounced in inflamed than in non-inflamed patients.

Conclusion

In ESKD systemic inflammation is a modifier of the relationship between LAVI, an integrate measure of LV filling pressure, and lung water. For any given pressure, lung water is increased with higher CRP levels, likely reflecting a higher permeability of the alveolar-capillary barrier.

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Acknowledgements

This study is part of the scientific activity of the EURECA-m (European Cardiovascular and Renal medicine) working group. The authors are grateful to Sarah Rocchi and Gennaro D’Angelo for their support during the LUST trial, and to Nancy CHRU University Hospital, France, which co-sponsored the trial in the French centres.

Funding

The LUST trial was funded by the European Renal Association-European Dialysis Transplantation Association (ERA-EDTA).

Author information

Authors and Affiliations

  1. Institute of Clinical Physiology-Pisa, National Research Council, Pisa, Italy

    Luna Gargani, Rosa Sicari & Eugenio Picano

  2. Institute of Clinical Physiology-Reggio Cal Unit, National Research Council, Reggio Calabria, Italy

    Claudia Torino, Rocco Tripepi, Francesca Mallamaci, Giovanni Tripepi & Carmine Zoccali

  3. Medical University, Wroclaw, Poland

    Krzysztof Letachowicz

  4. University of Opole, Opole, Poland

    Marian Klinger

  5. University Clinical Centre Maribor, Maribor, Slovenia

    Robert Ekart & Radovan Hojs

  6. Saarland University Hospital, Homburg, Germany

    Danilo Fliser, Sarah Seiler-Mußler & Fabio Lizzi

  7. Dr. C.I.Parhon Hospital, Iasi, Romania

    Adrian Covic & Dimitrie Siriopol

  8. University Hospital of Ioannina, Ioannina, Greece

    Kostas Siamopoulos & Olga Balafa

  9. IASIO Hospital-General Clinic of Kallithea, Kallithea, Greece

    Aristeidis Stavroulopoulos

  10. Ambroise Pare University Hospital, APHP, Paris-Ile-de France-Ouest University (UVSQ), INSERM U1018, Boulogne Billancourt, Paris, France

    Ziad A. Massy & Alexandre Seidowsky

  11. Dipartiment of Medicine and Surgery and Nephrology Unit, University Hospital Parma, Parma, Italy

    Enrico Fiaccadori & Giuseppe Regolisti

  12. C.T.M.R. Saint-Augustin, Bordeaux, France

    Thomas Bachelet

  13. Shaare Zedek Medical Center, Jerusalem, Israel

    Itzchak Slotki & Linda Shavit

  14. Bellvitge’s University Hospital-Hospitalet, Barcelona, REDinREN Instituto Salud Carlos III, Madrid, Spain

    Alberto Martinez-Castelao

  15. Centre D’Investigation Clinique Plurithématique Pierre Drouin-INSERM-CHRU de Nancy-Université de Lorraine and Institute Lorrain du Coeur Et de Vaisseaux Louis Mathieu, Vandœuvre-lès-Nancy, France

    Marie-Jeanne Coudert-Krier & Patrick Rossignol

  16. University Hospital Strasbourg, Strasbourg, France

    Thierry Hannedouche

  17. University of Silesia in Katowice, Katowice, Poland

    Andrzej Wiecek

  18. Aristotle University, Thessaloniki, Greece

    Pantelis Sarafidis & Charalampos Loutradis

  19. Università Di Ferrara, Ferrara, Italy

    Yuri Battaglia

  20. Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina

    Nejra Prohić

  21. Centre Hospitalier F.H. Manhès, Fleury-Mérogis, France

    Gérard Michel London

  22. FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network, Nancy, France

    Patrick Rossignol, Thierry Hannedouche & Gérard Michel London

  23. CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, 89124, Reggio Calabria, Italy

    Carmine Zoccali

Authors
  1. Claudia Torino
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  2. Luna Gargani
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  3. Rosa Sicari
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  4. Krzysztof Letachowicz
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  5. Robert Ekart
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  6. Danilo Fliser
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  7. Adrian Covic
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  8. Kostas Siamopoulos
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  9. Aristeidis Stavroulopoulos
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  10. Ziad A. Massy
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  11. Enrico Fiaccadori
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  12. Giuseppe Regolisti
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  13. Thomas Bachelet
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  14. Itzchak Slotki
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  15. Alberto Martinez-Castelao
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  16. Marie-Jeanne Coudert-Krier
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  17. Patrick Rossignol
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  19. Andrzej Wiecek
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  20. Pantelis Sarafidis
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  21. Yuri Battaglia
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  22. Nejra Prohić
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  23. Marian Klinger
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  24. Radovan Hojs
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  25. Sarah Seiler-Mußler
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  26. Fabio Lizzi
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  27. Dimitrie Siriopol
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  28. Olga Balafa
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  29. Linda Shavit
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  30. Charalampos Loutradis
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  31. Alexandre Seidowsky
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  32. Rocco Tripepi
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  33. Francesca Mallamaci
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  34. Giovanni Tripepi
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  35. Eugenio Picano
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  36. Gérard Michel London
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  37. Carmine Zoccali
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Contributions

CZ conceived the idea of the present analysis in the LUST database. CT, GD and GT performed the statistical analysis and CZ participated into the planning of the same analysis. CT and CZ prepared the first draft of the study which was critically read by all co-authors that eventually approved the final version of the manuscript prepared by CT and CZ.

Corresponding author

Correspondence to Carmine Zoccali.

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Conflict of interest

The authors declare no conflict of interest.

Ethical approval

This study fully complies with the guidelines for human studies and was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. The ethical committees of the Renal Units participating in the LUST trial approved the study protocol. All participants gave informed consent before enrolment.

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Torino, C., Gargani, L., Sicari, R. et al. Inflammation is an amplifier of lung congestion by high lv filling pressure in hemodialysis patients: a longitudinal study. J Nephrol 33, 583–590 (2020). https://doi.org/10.1007/s40620-019-00696-x

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