Inflammation is associated with carotid atherosclerosis in dialysis patients. Creed Investigators. Cardiovascular Risk Extended Evaluation in Dialysis Patients

J Hypertens. 2000 Sep;18(9):1207-13. doi: 10.1097/00004872-200018090-00006.


Objective: To investigate the relationship between inflammatory processes and atherosclerosis in uraemic patients on chronic dialysis.

Design: A cross-sectional study in 138 dialysis patients (92 on haemodialysis and 46 on continuous ambulatory peritoneal dialysis).

Methods: Serum C-reactive protein (CRP), IgG anti-Chlamydia pneumoniae antibodies, lipoprotein (a), fibrinogen and plasma homocysteine as well as the intima-media thickness and the number of atherosclerotic plaques of the carotid arteries (by Echo-Colour-Doppler) were measured in each patient

Results: One hundred and eight patients had at least one plaque and 26 had more than six plaques. Serum CRP was above the upper limit of the normal range (5 mg/I) in 85 of 138 patients (62%). IgG anti-Chlamydia pneumoniae antibodies were detectable in 64% of patients (high level in 24%, intermediate in 33% and low in 7%) and undetectable in the remaining 36% of patients. In a multiple regression model age (beta=0.35), serum CRP (beta=0.23), plasma homocysteine (beta=0.19), duration of dialysis (beta=0.19) and pulse pressure (beta=0.18) were independent predictors of intima-media thickness (R=0.54, P < 0.0001). Similarly, age (beta=0.33), serum CRP (beta=0.29), plasma homocysteine (beta=0.20) and serum albumin (beta=-0.18) were independent correlates of the number of atherosclerotic plaques (R = 0.55, P < 0.0001 ). Furthermore, in smokers, the interaction serum CRP-IgG anti-Chlamydia pneumoniae antibodies was the stronger independent predictor (beta=0.43, P=0.0001) of the number of atherosclerotic plaques while no such relationship (P=0.73) was found in non-smokers.

Conclusions: In patients on chronic dialysis treatment CRP is independently associated to carotid atherosclerosis and appears at least in part to be explained by IgG anti-Chlamydia pneumoniae antibodies level. These data lend support to the hypothesis that inflammation plays a role in the pathogenesis of atherosclerosis in these patients.

MeSH terms

  • Adult
  • Aged
  • Antibodies, Bacterial / blood
  • C-Reactive Protein / metabolism
  • Carotid Artery Diseases / diagnostic imaging
  • Carotid Artery Diseases / immunology*
  • Carotid Artery Diseases / microbiology
  • Chlamydia Infections / immunology*
  • Chlamydophila pneumoniae*
  • Female
  • Fibrinogen / analysis
  • Homocysteine / blood
  • Humans
  • Immunoglobulin G / blood
  • Kidney Failure, Chronic / immunology*
  • Kidney Failure, Chronic / microbiology
  • Kidney Failure, Chronic / therapy
  • Lipoprotein(a) / blood
  • Male
  • Membranes, Artificial
  • Middle Aged
  • Peritoneal Dialysis, Continuous Ambulatory*
  • Predictive Value of Tests
  • Regression Analysis
  • Renal Dialysis*
  • Ultrasonography, Doppler, Color
  • Uremia / immunology
  • Uremia / microbiology
  • Uremia / therapy


  • Antibodies, Bacterial
  • Immunoglobulin G
  • Lipoprotein(a)
  • Membranes, Artificial
  • Homocysteine
  • Fibrinogen
  • C-Reactive Protein