Chlamydia pneumoniae infection and ischemic heart disease in hemodialysis patien

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Chlamydia pneumoniae infection and ischemic heart disease in hemodialysis

patients.

Wszola M, Kwiatkowski A, Nosek R, Podsiadly E, Meszaros J, ewicz R,

Lisik W, Ostrowski K, Chmura A, Adadynski L, Paczek L, Durlik M,

Tylewska-Wierzbanowska S, Rowinski W.

Department of General and Transplantation Surgery, Warsaw Medical

University, ul. Nowogrodzka 59, 02-006 Warsaw, Poland. michal.wszola@...

INTRODUCTION: Ischemic heart disease and other atherosclerotic complications

are the prominent causes of death among hemodialyzed end-stage renal disease

(ESRD) patients and renal transplant recipients. Numerous articles in recent

years have raised the possibility of an infective factor, especially

Chlamydia pneumoniae, in the development of atherosclerosis and its

complications. The aim of this study was to assess the incidence of chronic

C pneumoniae infection and its association with ischemic heart disease and

atherosclerosis in a population of patients with ESRD awaiting renal

transplantation. MATERIAL AND METHODS: The studied group consisted of 164

subjects: 99 ESRD patients (heart disease [HD] group) who were hospitalized

for vascular access creation (27), pretransplantation nephrectomy (47), or

kidney transplantation (25), and a control group of 65 subjects consisting

of 50 healthy blood donors and 15 multiorgan donors. C pneumoniae was

detected in vascular wall fragments, kidney biopsy specimens and peripheral

blood monocytes using real time polymerase chain reaction (PCR). Serum

immunoglobulin IgG and IgA anti-C pneumoniae antibodies were detected using

Enzyme-linked immunosorbent assay (ELISA) and a lipid profile (cholesterol,

high-density lipoprotein [HDL], low-density lipoprotein [LDL], and

triglycerides [TG]) was obtained. Data on cardiovascular disease events,

smoking history, diabetes, hypertension, cause, and length of renal failure

were collected and analyzed. The existence of atherosclerotic lesions was

detected using ultrasound (US) Doppler examination of aortic bifurcation.

Chronic C pneumoniae infection was diagnosed on the basis of detection of

both IgA and IgG antibodies and/or the detection of C pneumoniae DNA in

vascular wall fragments or peripheral blood monocytes. After a follow-up of

32 months, data on cardiovascular events and patient history were collected

again. RESULTS: Chronic C pneumoniae infection affected 46.5% (46/99) of HD

patients and 9% (6/65) of controls (P < .05). Among HD patients, 26.3%

(26/99) had ischemic heart disease (IHD) versus 6% in the control group.

Among C pneumoniae-infected HD patients, IHD was more frequent (39.1%) than

in noninfected HD patients (15%; P < .05). Within the 32-month observation

period of the HD group, cardiac pain was observed in 11 (24%; 11/46)

infected patients versus 3 (5.7%; 3/53) patients without C pneumoniae

infection (P < .05). Exacerbation of previously diagnosed IHD was observed

in 8 (44%; 8/18) cases in the C pneumoniae-infected group versus 0 (0%; 0/8)

in the uninfected patients (P < .05). CONCLUSIONS: Chronic C pneumoniae

infection affects hemodialysis patients more frequently than healthy

subjects. Hemodialysis patients with C pneumoniae infection are at the

greater risk of exacerbation of existing IHD.

PMID: 16504656 [PubMed - indexed for MEDLINE]