Abstract
BackgroundCardiovascular disease is the major cause of death in patients with end-staged kidney disease (ESRD). Most ESRD patients have systemic inflammation, and increasing the risk of cardiovascular event. Endotoxin derived from lipopolysaccharide of Gram negative bacteria accounts for 70% of intestinal bacteria, leading to release of proinflammatory cytokines and negative cardiovascular effect. Impaired intestinal barriers have been found in some ESRD patients, and may lead to bacteria translocation from gastrointestinal tract. We aim to investigate the association of endotoxemia in ESRD patients and acute coronary syndrome (ACS).MethodsWe collected serum from adult ESRD patients who presented to emergency department (ED) with ACS (30 patients) or without ACS (30 patients) as control from 11/01/2013 to 10/31/2014 in Chi Mei Medical Center in southern Taiwan. Clinical information and lab data were collected. We measured the endotoxin level of the serum of ESRD patients with or without ACS. We used real-time 16S rDNA PCR to detect possible bacteria in the blood of the patients.ResultsThe endotoxin level of ESRD patients with ACS (0.49 (±0.12) EU/mL) was significantly higher than that of ESRD patients without ACS (0.1 ± 0.08) (p < 0.01). However, the endotoxin level was not correlated with the troponin-I level (r = −0.12). Although endotoxin level was higher in ESRD patients with ACS, bacteria were not detected in the serum by using the real-time 16S rDNA PCR.ConclusionEndotoxin in ESRD patients with ACS was significantly higher than that without ACS. The result suggested that endotoxemia may have a contributory role to cardiovascular disease in ESRD patients.
Highlights
Cardiovascular disease is the major cause of death in patients with end-staged kidney disease (ESRD)
Systemic inflammatory marker C-reactive protein (CRP) was positively correlated with endotoxin (r = 0.574, p = 0.007). Among those patients with acute coronary syndrome (ACS), there was no significant difference in endotoxin level between End-stage renal disease (ESRD) patients with pre-existing coronary artery disease (CAD) (0.45 ± 0.60 EU/mL) and without CAD (0.23 ± 0.44 EU/mL, p = 0.12) (Fig. 2)
Endotoxin level was higher in ESRD patients with ACS, nucleotide sequences of bacteria were not detected in the serum by the real-time 16S rDNA PCR
Summary
Cardiovascular disease is the major cause of death in patients with end-staged kidney disease (ESRD). Most ESRD patients have systemic inflammation, and increasing the risk of cardiovascular event. Endotoxin derived from lipopolysaccharide of Gram negative bacteria accounts for 70% of intestinal bacteria, leading to release of proinflammatory cytokines and negative cardiovascular effect. Impaired intestinal barriers have been found in some ESRD patients, and may lead to bacteria translocation from gastrointestinal tract. Cardiovascular disease is the major cause of death in patients with chronic kidney disease (CKD) [1]. Systemic inflammation increases the risk of cardiovascular disease in the CKD patient [2]. Endotoxin leads to release of proinflammatory cytokines which are connected with CD 14 of immune competent cells, resulting in negative cardiovascular effect, e.g., dilatation of peripheral vessels and impaired cardiac muscle contraction [5]
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