Nefro - 22-2.indd

Introduction: Patients with chronic kidney disease have greater mortality than the general population, mainly due to cardiovascular disease. Left ventricular hypertrophy, common in these patients, is also associated with increased mortality due to cardiovascular events. The prevalence of left ventricular hypertrophy and cardiovascular disease is influenced by traditional and emerging risk factors, such as inflammation. The aim of our study was to investigate the relationship between left ventricular hypertrophy and inflammatory markers in pre-dialysis patients. Subjects and Methods: This was a cross-sectional study into 69 pre-dialysis patients followed-up at our Low Clearance outpatient clinic. Several demographic, clinical, biochemical and inflammatory parameters were analysed. The prevalence of left ventricular hypertrophy was evaluated using the left ventricular mass index. The demographic, clinical, biochemical and inflammatory parameters analysed were compared in pre-dialysis patients with and without left ventricular hypertrophy. The relationship between inflammation and treatment with angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers and between inflammation and left ventricular mass index was also investigated. Results: Patients with chronic kidney disease presented higher inflammatory parameters than controls: 0.82±1.04 vs. 0.4±0.25 mg/dl, p=0.03 for hs-CRP; 5.3±5.6 vs. 2.1±0.37 mg/dl, p=0.002 for IL-6; and 11.6±8.9 vs. 4.5±1.2 mg/dl, p=0.0001 for TNF-α. The prevalence of left ventricular hypertrophy in chronic kidney disease patients was 66.4%. Patients with left ventricular hypertrophy tended not to be treated with angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers (17/6 vs. 23/23; p=0.058) and presented higher levels of IL-6 (6.2 vs. 3.4 pg/ml; p=0.015). We found a statistically significant relationship between the left ventricular mass index and hs-CRP (r=0.244, p=0.043) and IL-6 (r=0.338, p=0.004) levels. Conclusions: This study suggests that inflammation may contribute to the high prevalence of left ventricular hypertrophy in the pre-dialysis population. Key-Words: Chronic kidney disease; inflammation; left ventricular hypertrophy.