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NDT Advance Access published online on January 22, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn751
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Systemic inflammation is associated with pulmonary hypertension in patients undergoing haemodialysis

Tung-Min Yu1,4, Yi-Hsing Chen2,4, Jeng-Yuan Hsu3,5, Chung-Shu Sun6, Ya-Wen Chuang1,4, Cheng-Hsu Chen1,4, Ming-Ju Wu1,5, Chi-Hung Cheng1,4 and Kuo-Hsiung Shu1,5

1 Division of Nephrology 2 Division of Allergy, Immunology 3 Division of Chest Medicine 4 Department of Internal Medicine, Taichung Veterans General Hospital 5 Chung-Shan Medical University 6 Division of Pediatry, Zhong-Xing branch, Taipei City Hospital, Taiwan

Correspondence and offprint requests to: Kuo-Hsiung Shu, Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, 160, Chung-Kang Road, Sec. 3, Taichung, Taiwan. Tel: +886-4-23592525, Ext. 3040; Fax: +886-4-23594980; E-mail: khshu{at}vghtc.gov.tw



  Abstract

Background. Pulmonary hypertension (PH) is an overlooked cardiovascular morbidity in patients undergoing haemodialysis. Inflammation has been demonstrated to play a significant role with certain types of PH in non-uraemic patients, but studies analysing the mechanisms in dialyzed patients with PH are rare. Hence, we investigated systemic and local inflammation biomarkers associated with PH in uraemia patients to elucidate the potential mechanism.

Methods. A cross-sectional study was conducted in which 97 haemodialysis patients were initially evaluated in our hospital. Twelve inflammatory cytokines were measured using a cytometric beads assay in patients with and without PH. FENO (fractional exhaled nitric oxide) was checked by a chemiluminescence analyser in patients with and without PH as well as by normal controls.

Results. Thirty-nine eligible patients were enrolled. Compared to patients without PH (group A), patients with PH (group B) had significantly higher serum levels of hs-CRP, IL-1β, TNF-{alpha} and IL-6. FENO was also measured. Though the pre-dialysis FENO levels were elevated in both groups; group B patients had significantly higher pre-dialysis FENO levels than group A patients (39.9 ± 16.7 versus 31.8 ± 10.3, P = 0.045). The post-dialysis FENO levels returned to normal in group A while the remaining were significantly higher in group B (30.3 ± 10.3 versus 20.1 ± 10.9, P = 0.003).

Conclusions. Our study revealed that dialyzed patients with PH had a significantly higher level of airway FENO as well as serum levels of acute phase reactive protein and cytokines, including IL-1β, TNF-{alpha} and IL-6. A chronic inflammation might play an important role in the pathogenesis of PH in patients undergoing haemodialysis.

Keywords: fractional exhaled nitric oxide; haemodialysis; inflammatory cytokines; pulmonary hypertension

Received for publication: 12. 6.08
Accepted in revised form: 15.12.08


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