Atherosclerosis in Hemodialysis Patients—the Role of Microinflammation

Abstract

Introduction. Cardiovascular diseases (CVDs) are the most frequent cause of morbidity and mortality in patients with end-stage renal disease, and the risk for coronary heart disease is higher among the hemodialysis (HD) patients than in the general population. This excess risk for coronary heart disease is not entirely explained by traditional risk factors for CVDs. The aim of the study was to determine possible correlations between asymptomatic atherosclerosis and inflammatory markers (high sensitivity CRP [hsCRP], interleukin 6 [IL-6], tumor necrosis factor-alpha [TNF-α], interleukin 2 receptor [IL-2R], and selective adhesion molecules ICAM-1 and VCAM-1) in HD patients. Patients and methods. In our study, 95 HD patients, 56 (59%) male and 39 (41%) female, were included. The mean age was 60 ± 13 years, ranging from 22–81 years. Using B-mode ultrasonography (US), we measured intima-media thickness (IMT) and plaque occurrence (markers of asymptomatic atherosclerosis) in carotid arteries in these patients. In the 1–4 weeks after US examination, we took blood samples from patients to determine serum concentrations of inflammatory markers. Results. The mean IMT value was 0.83 ± 0.21 mm, ranging from 0.5 to 2 mm. The plaques were found in 63 (84%) of HD patients. Correlations between IMT values and serum concentrations of IL-2R (r = 0.269; p < 0.022) and VCAM-1 (r = 0.290; p < 0.014) were found. Multiple linear regression analysis showed relationship between IMT values and IL-2R (p = 0.049). No relationship between inflammatory markers and plaques was found. Conclusion. The results indicate that atherosclerosis in HD patients correlates with some nontraditional risk factors—the markers of inflammation.