The utılıty and importance of new cardiovascular disease determıners as an ındıcator of subclıcal cardıovascular abnormalıtıes in dialysıs patıents wıth symptomatıc hypervolemıa

In this study we aimed to determine the importance of subclinical cardiovascular abnormalities due to asymptomatic hypervolemia in patients with end stage renal disease (ESRD). We selected 78 ESRD patients maintaining on either peritoneal dailysis or hemodialysis treatment and 20 age-matched control patients. We used the new indicators of cardiovascular injury markers; which are Troponin I, Brain natriuretic peptid, cardiac type fatty acid binding protein, and as an indicator of inflammation h-CRP. To determine the volume status we measured the left ventricule mass and the diameter of vena cava inferior via an echocardiography devise. We randomized hemodialysis or peritoneal dialysis into subgroups according to vena cava inferior diameter and to the status of hypervolemia and normovolemia. We found vana cava inferior diameters higher than those in control group. However, the in-group comparision of hemodialysis and pertoneal dialysis were not significant. We found Tropoin I, C-FABP, hs-CRP, pro-BNP and LVMI, the indicators of cardiovascular injury in general population, higher than those in control group. We found a positive correlation between pro-BNP levels and left venricule mass index. Besides, we did not found any correlation between pro-BNP levels and Troponin I, cardiac type fatty acid binding protein, and hs-CRP, and also found no correlation betwen hs-CRP and LVMI. Plasma pro-BNP levels has already been used in symtomatic hypervolemia and congestive heart failure; therefore, it can be said that pro-BNP might provide useful information in ESRD patients. In several studies hs-CRP, Troponin I and cardiac fatty acid-binding proteins have been shown to be related to symtomatic cardivascular structural changes. The utility of these parameters in dialysis patients needs to be confirmed by studies which are larger and have well-defined patient groups.Keywords: hs-CRP, proBNP, Troponin, End stage renal disease, cardiac type fatty acid-binding protein, left ventricule mass index