2007 JASN IMPACT FACTOR 7.111	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wang, A. Y.-M. Articles by Sanderson, J. E. Search for Related Content PubMed PubMed Citation Articles by Wang, A. Y.-M. Articles by Sanderson, J. E.

Inflammation, Residual Kidney Function, and Cardiac Hypertrophy Are Interrelated and Combine Adversely to Enhance Mortality and Cardiovascular Death Risk of Peritoneal Dialysis Patients

Angela Yee-Moon Wang^*, Mei Wang^*, Jean Woo, Christopher Wai-Kei Lam, Siu-Fai Lui^*, Philip Kam-Tao Li^* and John E. Sanderson^*

*Department of Medicine & Therapeutics, Center for Nutritional Studies, Department of Chemical Pathology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, N.T. Hong Kong

Correspondence to Dr. Angela Yee-Moon Wang, Department of Medicine & Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, N.T. Hong Kong. Phone: 852-2632-3487; Fax: 852-2637-5396; E-mail: awang{at}cuhk.edu.hk

ABSTRACT. C-reactive protein (CRP), the prototype marker of inflammation, and cardiac hypertrophy are important prognostic indicators in dialysis patients. Residual renal function (RRF) has also been shown to influence survival of peritoneal dialysis (PD) patients. This study examined the relations between inflammation, RRF, and left ventricular hypertrophy (LVH) and determined whether inflammation, RRF, and LVH combine adversely to predict the outcomes of PD patients. A prospective observational study was performed in 231 chronic PD patients. Left ventricular mass index (LVMi), residual glomerular filtration rate (GFR), CRP, hemoglobin, serum albumin, and BP were determined at study baseline and related to outcomes. On univariate analysis, age (P = 0.002), dialysis duration (P = 0.004), coronary artery disease (P < 0.001), pulse pressure (P < 0.001), hemoglobin (P < 0.001), serum albumin (P = 0.032), log-CRP (P < 0.001), and GFR (P < 0.001) were significantly associated with log-LVMi. Log-CRP was positively correlated with pulse pressure (R = 0.218, P = 0.001) and negatively correlated with GFR (R = –0.272, P < 0.001). Multivariate analysis showed that log-CRP (P = 0.008) and RRF (P = 0.003) remained associated with log-LVMi independent of hemoglobin, serum albumin, arterial pulse pressure, and coronary artery disease. After follow-up for 30 ± 14 mo, 34.2% patients had died. CRP, RRF, and LVMi each were significantly predictive of all-cause mortality and cardiovascular death. Kaplan-Meier analysis showed a significant increase in all-cause (P < 0.0001) and cardiovascular mortality (P < 0.0001) as the number of risk factors, namely CRP 50th percentile, no RRF, and LVMi 50th percentile increased with the 2-yr all-cause mortality and cardiovascular death reaching as high as 61% and 46%, respectively, for patients who had all three risk factors. Compared with patients with none of the three risk factors, those with all three risk factors had an adjusted hazards ratio of 6.94 (P < 0.001) and 5.43 (P = 0.001) for all-cause mortality and cardiovascular mortality, respectively. In conclusion, inflammation, RRF, and LVH are interrelated and combine adversely to increase mortality and cardiovascular death risk of PD patients.

This article has been cited by other articles:

				B. Canaud Residual renal function: the delicate balance betweenbenefits and risks Nephrol. Dial. Transplant., June 1, 2008; 23(6): 1801 - 1805. [Full Text] [PDF]

				T. Gerhardt, U. Poge, B. Stoffel-Wagner, B. Klein, H.-U. Klehr, T. Sauerbruch, and R. P. Woitas Serum levels of beta-trace protein and its association to diuresis in haemodialysis patients Nephrol. Dial. Transplant., January 1, 2008; 23(1): 309 - 314. [Abstract] [Full Text] [PDF]

				S. C. W. Tang, Y. W. Ho, A. W. C. Tang, Y. Y. Cheng, F. H. Chiu, W. K. Lo, K. N. Lai, and for the Hong Kong Peritoneal Dialysis Study Group Delaying initiation of dialysis till symptomatic uraemia--is it too late? Nephrol. Dial. Transplant., July 1, 2007; 22(7): 1926 - 1932. [Abstract] [Full Text] [PDF]

				T. Omland, M. H. Drazner, T. Ueland, M. Abedin, S. A. Murphy, P. Aukrust, and J. A. de Lemos Plasma Osteoprotegerin Levels in the General Population: Relation to Indices of Left Ventricular Structure and Function Hypertension, June 1, 2007; 49(6): 1392 - 1398. [Abstract] [Full Text] [PDF]

				A. P.S. Kong, X. Yang, G. T.C. Ko, W.-Y. So, W.-B. Chan, R. C.W. Ma, V. W.S. Ng, C.-C. Chow, C. S. Cockram, P. C.Y. Tong, et al. Effects of Treatment Targets on Subsequent Cardiovascular Events in Chinese Patients With Type 2 Diabetes Diabetes Care, April 1, 2007; 30(4): 953 - 959. [Abstract] [Full Text] [PDF]

				R. Jofre, P. Rodriguez-Benitez, J. M. Lopez-Gomez, and R. Perez-Garcia Inflammatory Syndrome in Patients on Hemodialysis J. Am. Soc. Nephrol., December 1, 2006; 17(12_suppl_3): S274 - S280. [Abstract] [Full Text] [PDF]

				M. C. Matteucci, E. Wuhl, S. Picca, A. Mastrostefano, G. Rinelli, C. Romano, G. Rizzoni, O. Mehls, G. de Simone, F. Schaefer, et al. Left Ventricular Geometry in Children with Mild to Moderate Chronic Renal Insufficiency J. Am. Soc. Nephrol., January 1, 2006; 17(1): 218 - 226. [Abstract] [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673