Atherosclerosis in hemodialysis patients : relation to chronic inflammation and endothelial dysfunction

الملخص EN

Background : Cardiovascular disease is the principal cause of mortality in patients with end stage renal disease ( ESRD) undergoing hemodialysis (HD), the underlying mechanism is accelerated atherosclerosis.

Chronic inflammation and endothelial dysfunction are key events in the development of atherosclerosis, both are observed in haemodialysis patients.

The aim of this work was to study the relation of chronic inflammation and endothelial dysfunction to the increased incidence of atherosclerosis in HD patients.

Subjects & Method : This study included forty six patients with ESRD on maintenance HD for more than six months and twenty four healthy subjects, all were subjected to history taking, clinical examination, ECG, laboratory investigations including serum urea, creatinine, uric acid, fasting glucose, alanine amino transferase activity (ALT).

lipid profile, C reative protein (CRP), tumour necrosis factor alpha (TNF-α), endotoxin level, antichlamydia pneumoniae IgG and E-selectin.

Radiological examination included ultrasonography of carotid arteries and flow mediated vasodilatation of brachial artery (FMD).

Results : The mean intima media thickness (IMT) was higher in HD patients with evident carotid plaques among them.

Higher triglyceride (TG) and lower high density lipoprotein cholesterol (HDL-C ) among HD Patients, higher CRP, TNF-α, endotoxin and antiChlamydia pneumoniae (C pneumoniae) IgG than controls denoted chronic inflammation in HD patients.

Endothelial dysfunction was evident by high E-selectin level and low values of (FMD) in HD patients.

There was a significant negative correlation between CRP and FMD and also between FMD and IMT.

Conclusion : There was an increased prevalence of atherosclerosis in HD patients.

Chronic inflammation was evident among them.

Endotoxaemia has a definite role while C.

pneumoniae had trivial one for this chronic inflammatory state.

Endothelial dysfunction was confirmed in HD patients by high E-selectin level and impaired FMD.

There is an important link between chronic inflammation and endothelial dysfunction for the development and progression of atherosclerosis in HD patients.