Risco cardiovascular e sua associação com biomarcadores inflamatórios na doença renal crônica dialítica

Abstract

INTRODUCTION: Patients undergoing hemodialysis (HD) have a cardiovascular risk (CVR) considerably higher than that of the general population, because these individuals end up presenting specific organic and inflammatory changes, in addition to lesions induced by the replacement therapy. In those with chronic kidney disease (CKD), there is still a pro-inflammatory state that substantially contributes to the occurrence of CV events and that induces an acceleration of atherosclerosis. OBJECTIVE: The present study aims to evaluate the association of CVR with the inflammatory profile in chronic renal patients on dialysis. MATERIALS AND METHODS: This is a cross-sectional study, carried out in 3 tertiary hospitals, from the public and private sector, with the application of socioeconomic and clinical questionnaires (gender, age, background, life habits), laboratory evaluation (blood count, renal function, lipid profile, C-reactive protein – CRP, ferritin), measurement of inflammatory cytokines (IL-6 and TNFα) and assessment of cardiovascular risk score (Global Risk Score – ERG). RESULTS: Of 149 included participants, 76 (64.4%) were men, and the mean (SD) age was 58 (15) years. The adequacy of HD was measured through Kt/V, proving to be satisfactory in the sample. 81 (54.4%) were diabetic, 133 (89.3%) were hypertensive and 32 (21.5%) were obese. 36 participants were known to have heart disease, in addition to 8 others having already presented events resulting from significant obstruction. After stratification by CVR (105 (70.5%) at high risk and 44 (29.5%) at very high risk), observed associations were foind in the very high risk group: higher mean age; majority of elderly (56.8%) and diabetics (86.4%); high number of obese people (33.3% x 17.4%, p= 0.043); more than 80% without adequate control of LDL-c levels. CRP, IL-6 and TNFα were elevated but there was no statistically significant difference between groups. Ferritin was considerably higher in the very high risk group, 74% versus 27% (p< 0.001). In the combined analysis, ferritin x TNFα was higher in the very high risk group. Ferritin x TNFα x IL-6 showed the same trend. Ferritin had an AUC-ROC (with a 95% confidence interval) of 0.715, thus having a good measure of separability at the cut-off of 338.75ng/dL, with a sensitivity of 74.4% and specificity of 76%. (p< 0.001). Ferritin was associated to the cardiovascular event, (odds ratio, 1.005; 95% CI, 1.001-1.008; P= 0.009), evaluated by multivariable regression models. CONCLUSIONS: In this cross-sectional study, hypertension, diabetes, obesity and dyslipidemia have the greatest impact on cardiovascular events. Regarding the correlation with inflammatory biomarkers, ferritin and ferritinxTNFα are significantly higher in those individuals who have had a cardiovascular event.