Abstract: SA-PO845

Level of Anti-Cytomegalovirus Antibody Positively Correlates with Coronary Artery Disease and Cardiovascular Diseases in ESRD Patients

Session Information

Category: Dialysis

  • 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular

Authors

  • Yang, Feng-Jung, National Taiwan University, Taipei, Taiwan
  • Shu, Kai-Hsiang, Far Eastern Memorial Hospital, Banciao, New Taipei City, Taiwan
  • Chiu, Yen-Ling, Far Eastern Memorial Hospital, Banciao, New Taipei City, Taiwan
Background

Accumulating evidence indicates cytomegalovirus (CMV) infection is associated with several health-related adverse outcomes including atherosclerosis and premature mortality in individuals with normal renal function. Patients with end-stage renal disease (ESRD) exhibit impaired immune function and may face higher risk of CMV-related adverse outcomes. Whether level of anti-CMV immune response may associate with the prognosis of hemodialysis patients is unknown.

Methods

The immunity in ESRD study (iESRD) recruited 412 hemodialysis patients from both northern and southern Taiwan. By history taking and detailed chart reviews, baseline co-morbidities were recorded. Peripheral blood was sampled before hemodialysis session and processed immediately. Plasma levels of CMV-IgG and high-sensitivity C reactive protein were determined by ELISA. Peripheral blood monocyte and T cell differentiation subsets were determined by multicolor flow cytometry.

Results

Among these patients, 99% were CMV-seropositive. In the univariate analysis, log level of anti-CMV IgG was independently associated with the existence of coronary artery disease (OR=1.944, 95% CI=1.2~3.0, p=0.004) as well as cardiovascular diseases including stroke and peripheral arterial occlusive disease (OR=1.53, 95% CI=1.03~2.276, p=0.034). In a multivariate-adjusted logistic regression model, log level of anti-CMV IgG was independently associated with the existence of coronary artery disease (OR=1.944, 95% CI=1.2~10.4, p=0.019) as well as cardiovascular diseases including stroke and peripheral arterial occlusive disease (OR=3.98, 95% CI=1.5~10.8, p=0.007) after adjusting for age, gender, dialysis vintage, hemoglobin, DM, and hs-CRP. Level of anti-CMV IgG positively correlated with both percentage and absolute number of terminally differentiated CD8+CD45RA+CCR7- TEMRA cells, indicating the accumulation of these cells participate in the progression of atherosclerosis.

Conclusion

Anti-CMV humoral immune response positively correlates with the existence of coronary artery disease and cardiovascular diseases in ESRD patients. Role of CMV and the associated immune response should be further investigated in the pathogenesis of atherosclerosis in this patient population.

Funding

  • Government Support - Non-U.S.