Cytomegalovirus (CMV) and C-Reactive Protein (CRP) and their Association with Atherosclerosis in Patients with End Stage Renal Disease
Authors: Okba A M , Raafat M A , Farres M N , Melek N A , Doss M M , Gendy N N 
Published: May 2020

Abstract

Background
ESRD (end stage renal disease) is associated with an increase in the risk for cardiovascular disease, which can only be partially explained by known classical risk factors. However, chronic inflammation and endothelial dysfunction are key events in the development of atherosclerosis; both are observed in ESRD patients . The significance of C-Reactive Protein (CRP) and inflammation has increased over time, especially in the ESRD population. From being a simple marker, it now shown that CRP has an active participation in pro-atherosclerotic phenomenon including local pro-inflammatory and thrombotic events. Studies in the general population indicate the usefulness of CRP in prognosis and in monitoring response to therapy. Cytomegalovirus (CMV) is an important pathogen in immunocompromised individuals. Patients with ESRD display signs of frequent CMV re-activation, which may be caused by the uraemia-associated defect in cellular immunity. It has been well documented that hemodialysis patients have impaired immune response, which may result in higher prevalence rates of viral infections, including CMV. Infections in these patients may be due to primary infection or, more commonly, by reactivation of latent virus or re-infection with exogenous virus, which may be introduced by blood transfusion or kidney transplant. Infection with CMV is also considered a risk factor for progression of atherosclerotic disease.

Methods
CRP and CMV IgG level was measured in the blood samples of sixty adult patients diagnosed as ESRD, 30 ESRD patients with atherosclerotic changes(Group I) and 30 ESRD patients without atherosclerotic changes (Group II) and in comparison with 30 control subjects(Group III) (Control Group).

Results
The mean value of CRP in the control group (6.0 ± 4.2), the mean value in the ESRD patients with atherosclerotic changes group (15.8 ± 5.6) and the mean value in the ESRD patients without atherosclerotic changes group (11.2 ± 3.9),thus the mean values of CRP in ESRD patients groups were significantly higher than that of the control group (P &lt; 0.001) and the mean value of CRP in ESRD with atherosclerotic changes is significantly higher compared to ESRD without atherosclerotic changes group (P &lt; 0.001). Regarding CMV IgG antibodies it was significantly higher in ESRD patients compared to the control group and was also significantly higher in ESRD with atherosclerotic changes compared to ESRD without atherosclerotic changes.

Conclusions
ESRD are at greater risk of inflammatory reaction against factors originating from graft, fistula, dialysis membrane, infection sites. These reactions are associated with increased levels inflammatory markers such as serum CRP. Serum CRP seems to have a contribution in the development of cardiovascular complications in ESRD patients.CMV seropositivity is also significantly associated with atherosclerotic disease in ESRD patients. Our data suggest that the risk for progressive atherosclerosis is specifically increased in patients with an inflammatory response to CMV and elevated CRP level.