SUN-270 Atherosclerotic vascular disease and inflammation in CKD patients in South Africa

Abstract

Chronic inflammation is a known risk factor for cardiovascular disease (CVD) among chronic kidney disease (CKD) patients. Current evidence supports the pivotal role of inflammation in atherosclerosis, which is reinforced by the association between traditional inflammatory markers, such as the high sensitivity C-reactive protein (hs-CRP), and CVD. We evaluated the association between inflammatory markers and atherosclerotic vascular disease (AsVD) in stage 3 CKD, end-stage kidney disease (ESKD) patients on dialysis and kidney transplant recipients (KTRs). This was a cross-sectional study of 40 adult (aged 18-65 years) non-diabetic stage 3 CKD patients, 40 peritoneal dialysis (PD) patients, 40 haemodialysis (HD) patients, 41 KTRs and 41 age- and sex-matched healthy controls. Serum was analysed for creatinine, albumin, lipid profile and inflammatory markers including hs-CRP, pentraxin-3, tumour necrosis factor alpha (TNF-α) and the ligand of the receptor for advanced glycation end-products (EN-RAGE). Echocardiography was performed on all patients and carotid intima media thickness (CIMT) was assessed in both right and left carotid arteries at 1 cm proximal to the carotid bulb. The levels of all the inflammatory markers assessed were elevated in CKD patients compared to controls. Pentraxin-3 levels were significantly higher in stage 3 CKD, PD, HD and KTRs (p < 0.05) compared to controls, while hs-CRP levels were significantly increased in stage 3 CKD, PD and HD patients, (p < 0.05). Tumour necrosis factor-alpha levels were significantly higher in PD patients compared to controls, (p < 0.001). EN-RAGE levels were significantly higher among KTRs compared to controls, (p < 0.05). Age, increased WHR and low HDL-C levels were associated with AsVD. Pentraxin-3 correlated positively with other inflammatory markers (except hs-CRP) and negatively with serum albumin levels (r = -0.316, p = 0.004). Hypertension, elevated total cholesterol, TNF-α and EN-RAGE levels were predictors of high pentraxin-3 levels while age (> 40 years) [OR 5.18, p < 0.001], the male gender [OR 2.45, p = 0.031] and low HDL-C [OR 2.93, p = 0.009] independently predicted AsVD. Inflammation is present in all the kidney disease groups and persists in the post-transplant period. Age (> 40 years), male gender and low HDL-C independently predicted AsVD. Aggressive treatment of lipid disorders and eradication of inflammation may be beneficial in reducing the burden of CVD in CKD.