Comparison of Body Composition and Inflammatory Markers in End Stage Renal Disease Patients with Atherosclerosis and Patients with Coronary Artery Disease

Abstract

Background: Cardiovascular diseases are the primary cause of mortality and morbidity among patients on dialysis for end stage renal disease (ESRD). Persistent inflammation is common among the clinical conditions where obesity paradox is applied. It is important to know how body composition and inflammatory markers differ between patients with coronary artery disease (CAD) and ESRD, since it can help to understand the distinct pathogenesis in them. Objectives: To compare the body composition and systemic inflammation in patients with ESRD with atherosclerosis and patients with CAD Methods: Patients with ESRD on haemodialysis awaiting kidney transplant at Teaching Hospitals, Karapitiya (THK) and Kandy and patients with CAD, awaiting coronary artery bypass graft (CABG) at the Cardio-thoracic Unit of THK were studied. An arterial tissue biopsy (from renal and external iliac artery of ESRD patients and from aorta of CAD patients) was collected for histological assessment. Inflammatory markers, interleukin-6 and high sensitivity C-reactive protein (Hs-CRP) were estimated and dual energy x-ray absorptiometry scan was performed to assess the body composition. Results: Out of 43 ESRD patients and 50 CAD patients recruited, atherosclerosis was present in the arterial/aortic biopsies of 25 patients with ESRD and 49 patients with CAD. Mean (SD) age of the ESRD patients with atherosclerosis (46(11) yrs) was significantly lower compared to CAD (54 (6) yrs) patients. Mean (SD) BMI of the ESRD patients (22.0 (3.7) kg/m2) was significantly lower (p=<0.001) compared to CAD patients (25.4 (3.6) kg/m2), total body bone mineral content (TBBMC) of ESRD patients (1802.9 (332.0)g) was significantly lower (p=<0.001) compared to CAD patients(2129.5 (298.4)g), total body lean mass (TBLM) of ESRD patients (36186.6 (10126.2)g) was significantly lower (p=<0.001) compared to CAD patients (44662.4 (6911.5)g), total body bone mineral density (TBBMD) of ESRD patients (1.03 (0.1) g/cm2) was significantly lower (p=0.003) compared to CAD patients (1.12 (0.08) g/cm2) and significantly higher Hs-CRP (p=0.005) level was observed in ESRD patients (2 (3.3) mg/L) compared to patients with CAD (1 (3.6)mg/L. Conclusions: Patients with ESRD were had lower BMI, TBBMC, TBBMD and TBLM and higher Hs-CRP compared to patients with CAD. Low TBBMD, TBBMC and TBLM are likely manifestations of severe vascular disease among ESRD patients. Keywords: Body composition, Coronary artery disease, End stage renal disease