Chlamydial infection and progression of carotid atherosclerosis in patients on regular haemodialysis

• Published in: Nephrology, dialysis, transplantation Vol. 19; no. 10; pp. 2539 - 2546
• Main Authors: Kato, Akihiko, Takita, Takako, Maruyama, Yukitaka, Hishida, Akira
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.10.2004
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; C-Reactive Protein - metabolism; Cardiovascular Diseases - complications; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - microbiology; carotid wall intima medial thickness; Chlamydia pneumoniae; Chlamydophila Infections - complications; Chlamydophila pneumoniae; Chronic Disease; Creatinine - blood; Disease Progression; Emergency and intensive care: renal failure. Dialysis management; Female; haemodialysis; Human viral diseases; Humans; hypoalbuminaemia; Immunoglobulin A - blood; Infectious diseases; Intensive care medicine; interleukin-6; Interleukin-6 - blood; Intracranial Arteriosclerosis - diagnostic imaging; Intracranial Arteriosclerosis - microbiology; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Longitudinal Studies; Male; Medical sciences; Middle Aged; Prospective Studies; Renal Dialysis; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tunica Intima - diagnostic imaging; Tunica Media - diagnostic imaging; Ultrasonography; Viral diseases; Viral hepatitis; Kidney disease; Human; Chlamydia pneumoniae; Urinary system disease; Hemodialysis; haemodialysis; Cardiovascular disease; interleukin-6; Vascular disease; Infection; Interleukin 6; Extrarenal dialysis; carotid wall intima medial thickness; hypoalbuminaemia; Carotid; Atherosclerosis; Renal failure
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfh416

Background. Recent findings have suggested a possible contribution of chlamydial infection to the pathogenesis of atherosclerosis in the general population. However, the role that chlamydial antibody status plays in atherosclerosis generation in haemodialysis (HD) patients remains uncertain. Methods. We measured carotid artery intima medial thickness (IMT) over 4 years in 100 HD subjects (age: 58±10 years; time on HD: 13±7 years; male/female: 67/33) and examined potential associations between Chlamydia pneumoniae (Cp) antibody seropositivity and changes in carotid artery IMT. Results. During 4 years, carotid artery IMT increased significantly from 0.62±0.13 to 0.73±0.12 mm (P< 0.01). IMT progression was significantly and positively correlated with age (r = 0.37, P<0.01), log-transformed C-reactive protein (CRP; r = 0.33, P<0.01) and log-transformed interleukin-6 (IL-6; r = 0.22, P<0.04), but inversely correlated with blood creatinine (r = −0.36, P<0.01) and albumin (r = −0.24, P<0.02). IMT increases were more prominent in patients positive for IgA antibodies (0.039± 0.022 mm/year, n = 52) compared with those without IgA antibodies (0.025±0.032 mm/year, n = 48) (P<0.01). IgA seropositivity did not accelerate IMT progression in patients with increased CRP (>0.11 mg/dl, n = 53), but significantly increased IMT to a greater extent in IgA-positive subjects than in IgA-negative subjects having lower CRP (≤0.11 mg/dl, n = 47) (0.017±0.024 vs 0.034± 0.021 mm/year; P = 0.01). Multivariate regression analysis revealed that serum creatinine, log-transformed CRP and IgA Cp seropositivity were independent risk factors for IMT progression (P<0.01). In contrast, IgG Cp antibody did not affect IMT progression or carotid plaque formation. Conclusions. IMT progression is associated with inflammation and malnutrition. In addition, persistent chlamydial infection may be associated with IMT progression, but only in HD patients having low blood CRP.