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NDT Advance Access published online on June 14, 2005
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfh906
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received November 29, 2004
Accepted April 20, 2005

Original Articles

Close association of Chlamydia pneumoniae IgA seropositivity by ELISA with the presence of coronary artery stenosis in haemodialysis patients

Masato Nishimura 1*, Tetsuya Hashimoto 2, Hiroyuki Kobayashi 2, Toyofumi Fukuda 2, Koji Okino 3, Noriyuki Yamamoto 2, Chikako Mashida 4, Kiyotaka Kawagoe 4, Hiroshi Fujita 5, Naoto Inoue 5, Hakuo Takahashi 6, and Toshihiko Ono 2

1 Cardiovascular Division, Toujinkai Hospital, Kyoto, Japan
2 Division of Urology, Toujinkai Hospital, Kyoto, Japan
3 Division of Surgery, Toujinkai Hospital, Kyoto, Japan
4 Pharmaceutical Research Laboratory, Hitachi Chemical Company, Ibaraki, Japan
5 Department of Interventional Cardiology, Kyoto Second Red Cross Hospital, Kyoto, Japan
6 Department of Clinical Sciences and Laboratory Medicine, Kansai Medical University, Moriguchi, Japan

* To whom correspondence should be addressed.
Masato Nishimura, E-mail: mnishimura{at}tea.ocn.ne.jp



  Abstract

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. Chlamydia 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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