Cytomegalovirus seropositivity is independently associated with cardiovascular disease in non-dialysis dependent chronic kidney disease.
Cytomegalovirus seropositivity is independently associated with cardiovascular disease in non-dialysis dependent chronic kidney disease.
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DOI：
10.1093/qjmed/hcz258
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发表时间：
2019-10
期刊：
影响因子：
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通讯作者：
Alvin H K Karangizi;Dimitrios Chanouzas;Anthony Fenton;P. Moss;P. Cockwell;C. Ferro;L. Harper
中科院分区：
文献类型：
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作者：
Alvin H K Karangizi;Dimitrios Chanouzas;Anthony Fenton;P. Moss;P. Cockwell;C. Ferro;L. Harper
背景心血管疾病(CVD)是慢性肾脏病(CKD)患者早期死亡的主要原因。先前的工作已经描述了在依赖透析的终末期肾病患者中，CMV血清阳性与心血管疾病之间的关系。CMV血清阳性是否与非透析依赖型CKD患者的心血管疾病相关尚不确定。目的探讨既往巨细胞病毒感染与非透析依赖型慢性肾脏病患者心血管疾病的相关性。设计一项采用二次护理中肾损伤(RIISC)队列的回顾性观察研究，这是一项评估进展性慢性肾脏病患者预后的生物临床决定因素的研究。方法对764例CKD患者透析前2~5期患者的血清标本进行抗CMV-Ig G抗体检测，并探讨其与常见心血管疾病的关系。结果EGFR中位数为24ml/min/1.73m2(IQR19~32)。68%的患者CMV血清阳性。CMV血清阳性与年龄较大、非高加索人种、糖尿病和较高的社会剥夺指数得分有关。在单变量分析中，巨细胞病毒血清阳性与较高的收缩压(p=0.044)、常见的心血管疾病(p<；0.001)、缺血性心脏病(p<；0.001)和脑血管疾病(p=0.022)相关。在多变量分析中，巨细胞病毒血清阳性患者患心血管疾病的可能性几乎是血清阴性患者的两倍(OR=1.998，CI 1.231-3.242，p=0.005)。结论在非透析CKD患者中，CMV血清阳性与心血管疾病的高患病率独立相关。
BACKGROUND Cardiovascular disease (CVD) is the leading cause of early death in patients with chronic kidney disease (CKD). Previous work has described an association between CMV seropositivity and cardiovascular disease amongst patients with dialysis dependent end stage renal disease. Whether CMV seropositivity is associated with cardiovascular disease in non-dialysis dependent CKD has not been established. AIM Investigate whether past CMV infection is associated with prevalent cardiovascular disease in patients with non-dialysis dependent CKD. DESIGN A retrospective observational study using the Renal Impairment in Secondary Care (RIISC) cohort, a study evaluating bio-clinical determinants of outcomes in patients with progressive CKD. METHODS We assayed cryopreserved serum samples collected at inception for anti-CMV IgG antibodies from 764 patients with stages 2 to 5 CKD (pre-dialysis) and investigated its relationship with prevalent cardiovascular disease. RESULTS Median eGFR was 24 ml/min/1.73m2 (IQR 19-32). Sixty-eight percent of patients were CMV seropositive. CMV seropositivity was associated with older age, non-Caucasian ethnicity, diabetes and higher social deprivation index score. On univariable analysis, CMV seropositivity correlated with higher systolic blood pressure (p = 0.044), prevalent cardiovascular disease (p < 0.001), ischaemic heart disease (p < 0.001) and cerebrovascular disease (p = 0.022). On multivariable analysis, CMV seropositive patients nearly twice as likely to have cardiovascular disease compared to seronegative patients (OR = 1.998, CI 1.231-3.242, p = 0.005). CONCLUSIONS In patients with non-dialysis CKD, CMV seropositivity is independently associated with a higher prevalence of cardiovascular disease.