NDT Advance Access originally published online on June 14, 2005
Nephrology Dialysis Transplantation 2005 20(9):1944-1950; doi:10.1093/ndt/gfh906
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Close association of Chlamydia pneumoniae IgA seropositivity by ELISA with the presence of coronary artery stenosis in haemodialysis patients
1 Cardiovascular Division, 2 Division of Urology, and 3 Division of Surgery, Toujinkai Hospital, 5 Department of Interventional Cardiology, Kyoto Second Red Cross Hospital, Kyoto, 4 Pharmaceutical Research Laboratory, Hitachi Chemical Company, Ibaraki and 6 Department of Clinical Sciences and Laboratory Medicine, Kansai Medical University, Moriguchi, Japan
Correspondence and offprint requests to: Masato Nishimura, MD, Cardiovascular Division, Toujinkai Hospital, 16 Negoro, Momoyama-cho, Fushimi-ku, Kyoto, 612-8024 Japan. Email: mnishimura{at}tea.ocn.ne.jp
Background. Traditional risk factors of cardiovascular disease do not fully explain the accelerated atherosclerosis present in patients with end-stage renal disease (ESRD). The goal of this study was to identify the association of clinical and laboratory factors including seropositivity for Chlamydia pneumoniae determined by a specific enzyme-linked immunosorbent assay (ELISA) with the presence of coronary artery disease identified by coronary angiography in ESRD patients.
Methods. We prospectively enrolled 161 consecutive ESRD patients undergoing haemodialysis for >6 months (106 men, 55 women; mean age 63.1±10.2 years; mean dialysis duration 91.3±90.1 months). All patients underwent coronary angiography within 1 week after blood sampling. The associations of coronary artery disease with clinical parameters including C. pneumoniae IgA and IgG seropositivity were analysed using multiple logistic regression models.
Results. Coronary stenosis >50% was found in 102 of 161 haemodialysis patients (63.4%). Of the 102 patients, 75.5% were asymptomatic. Seropositivity for C. pneumoniae IgA was found in patients with coronary stenosis (77 out of 102, 75.5%) more frequently (P<0.001) than in patients without coronary stenosis (10 out of 59, 16.9%). Seropositivity for C. pneumoniae IgA but not IgG was strongly associated with the presence of coronary stenosis in multiple logistic regression analysis (odds ratio, 18.440; 95% confidence interval, 7.500–45.337), independently of the Framingham coronary risk factors, factors peculiar to ESRD or serum C-reactive protein levels.
Conclusions. C. pneumoniae IgA seropositivity determined by ELISA is an independent laboratory factor indicating the presence of coronary artery stenosis in ESRD patients undergoing maintenance haemodialysis.
Keywords: Chlamydia pneumoniae; coronary artery disease; ELISA; end-stage renal disease; haemodialysis; IgA
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