European Journal of Internal Medicine 25 (2014) e88
Contents lists available at ScienceDirect
European Journal of Internal Medicine journal homepage: www.elsevier.com/locate/ejim
Letter to the Editor Incidence and risk factors of atherosclerotic cardiovascular accidents in dialysis chronic renal failure patients Keywords: Cardiovascular accidents Chronic renal failure Cardiovascular morbidity and mortality
Patients in different stages of chronic renal failure, particularly hemodialysis patients, exhibit increased incidence of cardiovascular morbidity and mortality (CVD) in comparison with the other patient population [1]. Aside from the traditional risk factors involved in the development of atherosclerosis (hypertension, smoking, obesity, lipid metabolism disorders) inflammation is nowadays attributed the most important role in the process of atherosclerosis. Reactants of the acute inflammatory phase, e.g. C-reactive protein (CRP), interleukin-6 (IL-6), fibrinogen, were proven strong predictors of cardiovascular morbidity and mortality in patients with chronic renal failure. Our prospective study, extending over one-year-period, involved 168 subjects, which were distributed in three groups: group 1 (n = 64) — patients in the pre-dialysis stage; group 2 (n = 69) — patients in dialysis stage; and group 3 (n = 35) — healthy subjects. In the course of the investigation groups 1 and 2 were further distributed in two subgroups, according to the incidence of cardiovascular complications. The following parameters were determined in three-month intervals: CRP, IL-6 (at the beginning and at the end of the investigation), fibrin ogen, electrophoresis (EF) of serum proteins, erythrocyte sedimentation, blood count, urea, creatinine, creatinine clearance, electrolytes, lipid status, and apolipoprotein A1. Statistical evaluation of the obtained results revealed the highest values for reactants of the acute inflammatory phase in dialysis patients with evident cardiovascular complications, while the lowest values were observed in patients in pre-dialysis stadium without cardiovascular complications; however, showing increasing tendency. Investigated the acute inflammatory phases of the reactants are increased in patients in different stages of renal insufficiency. The highest values of CRP, IL-6 and fibrinogen in patients on chronic dialysis with CVD, and the lowest be observed in the predialysis stage without CVD. The test parameters CRP, IL-6, fibrinogen, and serum albumin were confirmed as good indicators of inflammation, which is one of the most important factors in the process of atherosclerosis in patients with chronic renal failure. Thus it can be considered as predictors of cardiovascular morbidity and mortality in this group of patients, especially patients in stage IV chronic kidney failure. The most important characteristics of lipid disorders in our patients are hypertriglyceridemia, lowering HDL cholesterol, LDL cholesterol and A1. The survey found a significant correlation between the acute inflammatory phase
reactants (CRP, IL 6, fibrinogen, serum albumin) and lipid parameters, particularly in patients on chronic dialysis without CVD, while the least pronounced in patients in the predialysis stage without CVD [2–5]. It would be advisable to be within the recommendations for lipid (European Guide and NCEP ATP III in 2003), it is necessary to apply more stringent criteria in relation to the adequate treatment of incidence and risk factors of atherosclerotic cardiovascular accidents in dialysis chronic renal failure patients. Funding No specific funding was received for this study. Conflict of interest statement None to declare. References [1] Haase M, Devarajan P, Haase-Fielitz A, Bellomo R, Cruz DN, Wagener G, et al. The outcome of neutrophil gelatinase-associated lipocalin-positive subclinical acute kidney injury a multicenter pooled analysis of prospective studies. J Am Coll Cardiol 2011;57:1752–61. [2] Damman K, Van Veldhuisen DJ, Navis G, Vaidya VS, Smilde TD, Westenbrink BD, et al. Tubular damage in chronic systolic heart failure is associated with reduced survival independent of glomerular filtration rate. Heart 2010;96:1297–302. [3] Damman K, Masson S, Hillege HL, Maggioni AP, Voors AA, Opasich C, et al. Clinical outcome of renal tubular damage in chronic heart failure. Eur Heart J 2011;32: 2705–12. [4] Bonventre JV, Yang L. Kidney injury molecule-1. Curr Opin Crit Care 2010;16:556–61. [5] Jungbauer CG, Birner C, Jung B, Buchner S, Lubnow M, von Bary C, et al. Kidney injury molecule-1 and N-acetyl-b-D-glucosaminidase in chronic heart failure: possible biomarkers of cardiorenal syndrome. Eur J Heart Fail 2011;13:1104–10.
Djurdjević Mirković Tatjana Clinical Centre of Vojvodina, Serbia University of Novi Sad, Faculty of Medicine Novi Sad, Serbia Mirković Siniša Clinic for dentistry, Novi Sad, Serbia University of Novi Sad, Faculty of Medicine Novi Sad, Serbia Gvozdenović Ljiljana⁎ Petrović Lada Ćelić Dejan Clinical Centre of Vojvodina, Serbia University of Novi Sad, Faculty of Medicine Novi Sad, Serbia ⁎Corresponding author at: Clinical Center of Vojvodina, Novi Sad, Serbia. Tel.: +38163 529 409; fax+38121 423 902. E-mail address: [email protected] (G. Ljiljana).
http://dx.doi.org/10.1016/j.ejim.2014.06.019 0953-6205/© 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
23 May 2014
Contents lists available at ScienceDirect
European Journal of Internal Medicine journal homepage: www.elsevier.com/locate/ejim
Letter to the Editor Incidence and risk factors of atherosclerotic cardiovascular accidents in dialysis chronic renal failure patients Keywords: Cardiovascular accidents Chronic renal failure Cardiovascular morbidity and mortality
Patients in different stages of chronic renal failure, particularly hemodialysis patients, exhibit increased incidence of cardiovascular morbidity and mortality (CVD) in comparison with the other patient population [1]. Aside from the traditional risk factors involved in the development of atherosclerosis (hypertension, smoking, obesity, lipid metabolism disorders) inflammation is nowadays attributed the most important role in the process of atherosclerosis. Reactants of the acute inflammatory phase, e.g. C-reactive protein (CRP), interleukin-6 (IL-6), fibrinogen, were proven strong predictors of cardiovascular morbidity and mortality in patients with chronic renal failure. Our prospective study, extending over one-year-period, involved 168 subjects, which were distributed in three groups: group 1 (n = 64) — patients in the pre-dialysis stage; group 2 (n = 69) — patients in dialysis stage; and group 3 (n = 35) — healthy subjects. In the course of the investigation groups 1 and 2 were further distributed in two subgroups, according to the incidence of cardiovascular complications. The following parameters were determined in three-month intervals: CRP, IL-6 (at the beginning and at the end of the investigation), fibrin ogen, electrophoresis (EF) of serum proteins, erythrocyte sedimentation, blood count, urea, creatinine, creatinine clearance, electrolytes, lipid status, and apolipoprotein A1. Statistical evaluation of the obtained results revealed the highest values for reactants of the acute inflammatory phase in dialysis patients with evident cardiovascular complications, while the lowest values were observed in patients in pre-dialysis stadium without cardiovascular complications; however, showing increasing tendency. Investigated the acute inflammatory phases of the reactants are increased in patients in different stages of renal insufficiency. The highest values of CRP, IL-6 and fibrinogen in patients on chronic dialysis with CVD, and the lowest be observed in the predialysis stage without CVD. The test parameters CRP, IL-6, fibrinogen, and serum albumin were confirmed as good indicators of inflammation, which is one of the most important factors in the process of atherosclerosis in patients with chronic renal failure. Thus it can be considered as predictors of cardiovascular morbidity and mortality in this group of patients, especially patients in stage IV chronic kidney failure. The most important characteristics of lipid disorders in our patients are hypertriglyceridemia, lowering HDL cholesterol, LDL cholesterol and A1. The survey found a significant correlation between the acute inflammatory phase
reactants (CRP, IL 6, fibrinogen, serum albumin) and lipid parameters, particularly in patients on chronic dialysis without CVD, while the least pronounced in patients in the predialysis stage without CVD [2–5]. It would be advisable to be within the recommendations for lipid (European Guide and NCEP ATP III in 2003), it is necessary to apply more stringent criteria in relation to the adequate treatment of incidence and risk factors of atherosclerotic cardiovascular accidents in dialysis chronic renal failure patients. Funding No specific funding was received for this study. Conflict of interest statement None to declare. References [1] Haase M, Devarajan P, Haase-Fielitz A, Bellomo R, Cruz DN, Wagener G, et al. The outcome of neutrophil gelatinase-associated lipocalin-positive subclinical acute kidney injury a multicenter pooled analysis of prospective studies. J Am Coll Cardiol 2011;57:1752–61. [2] Damman K, Van Veldhuisen DJ, Navis G, Vaidya VS, Smilde TD, Westenbrink BD, et al. Tubular damage in chronic systolic heart failure is associated with reduced survival independent of glomerular filtration rate. Heart 2010;96:1297–302. [3] Damman K, Masson S, Hillege HL, Maggioni AP, Voors AA, Opasich C, et al. Clinical outcome of renal tubular damage in chronic heart failure. Eur Heart J 2011;32: 2705–12. [4] Bonventre JV, Yang L. Kidney injury molecule-1. Curr Opin Crit Care 2010;16:556–61. [5] Jungbauer CG, Birner C, Jung B, Buchner S, Lubnow M, von Bary C, et al. Kidney injury molecule-1 and N-acetyl-b-D-glucosaminidase in chronic heart failure: possible biomarkers of cardiorenal syndrome. Eur J Heart Fail 2011;13:1104–10.
Djurdjević Mirković Tatjana Clinical Centre of Vojvodina, Serbia University of Novi Sad, Faculty of Medicine Novi Sad, Serbia Mirković Siniša Clinic for dentistry, Novi Sad, Serbia University of Novi Sad, Faculty of Medicine Novi Sad, Serbia Gvozdenović Ljiljana⁎ Petrović Lada Ćelić Dejan Clinical Centre of Vojvodina, Serbia University of Novi Sad, Faculty of Medicine Novi Sad, Serbia ⁎Corresponding author at: Clinical Center of Vojvodina, Novi Sad, Serbia. Tel.: +38163 529 409; fax+38121 423 902. E-mail address: [email protected] (G. Ljiljana).
http://dx.doi.org/10.1016/j.ejim.2014.06.019 0953-6205/© 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
23 May 2014
