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NDT Advance Access published online on June 27, 2007
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfm348
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Seropositivity for cytomegalovirus in patients with end-stage renal disease is strongly associated with atherosclerotic disease

Michiel G. H. Betjes, Nicolle H. R. Litjens and Robert Zietse

Erasmus Medical Center, Department of Internal Medicine, Division of Nephrology, Rotterdam, The Netherlands

Correspondence and offprint requests to: Michiel G. H. Betjes, MD, PhD, Erasmus Medical Center, Department of Internal Medicine, Division of Nephrology, Dr Molewater plein 40 3015 GD Rotterdam, The Netherlands. Email: M.G.H.Betjes{at}erasmusmc.nl



  Abstract

Background. Infection with cytomegalovirus (CMV) is considered a risk factor for progression of atherosclerotic disease. Patients with end-stage renal disease (ESRD) display signs of frequent CMV re-activation, which may be caused by the uraemia-associated defect in cellular immunity. The possible contribution of CMV seropositivity to the hugely increased risk for cardiovascular disease in patients with ESRD is not clear.

Methods. In a retrospective study we analysed the clinical data of patients with ESRD that were evaluated for renal transplantation from January 2002 to March 2006. Classical cardiovascular risk factors and CMV seropositivity were related to the prevalence of atherosclerotic disease.

Results. A total of 408 patients were evaluated with a median age of 52 years (range 18–81 years). Multivariate logistic regression identified age (odds ratio; OR 2.7 per decade), smoking (OR 2.2), hypertension (OR 1.9), C-reactive protein (CRP) (OR 2.6) and CMV seropositivity (OR 2.7) as independent variables that were significantly associated with a positive medical history of atherosclerotic disease. The average titre for anti-CMV immunoglobulin G was higher in patients with atherosclerotic disease (100 AU/ml vs 71 AU/ml, P < 0.05). CMV seropositivity was independently associated with an elevated CRP. In addition, patients with the combination of a high CRP and CMV seropositivity showed the highest prevalence of atherosclerotic disease.

Conclusion. CMV seropositivity is significantly associated with atherosclerotic disease in ESRD patients. Our data suggest that the risk for progressive atherosclerosis is specifically increased in patients with an inflammatory response to CMV.

Keywords: atherosclerotic disease; C-reactive protein; cytomegalovirus; end-stage renal disease

Received for publication: 7. 3.07
Accepted in revised form: 8. 5.07


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