Introduction: Since inflammation alters vascular permeability, including vascular permeability in the lung, we hypothesized that it can be an amplifier of lung congestion in a category of patients at high risk for pulmonary oedema like end stage kidney disease (ESKD) patients. Objective and methods: We investigated the effect modification by systemic inflammation (serum CRP) on the relationship between a surrogate of the filling pressure of the LV [left atrial volume indexed to the body surface area (LAVI)] and lung water in a series of 220 ESKD patients. Lung water was quantified by the number of ultrasound B lines (US-B) on lung US. Six-hundred and three recordings were performed during a 2-year follow up. Longitudinal data analysis was made by the Mixed Linear Model. Results: At baseline, 88 had absent, 101 had mild to moderate lung congestion and 31 severe congestion. The number of US B lines associated with LAVI (r = 0.23, P < 0.001) and serum CRP was a robust modifier of this relationship (P < 0.001). Similarly, in fully adjusted longitudinal analyses US-B lines associated with simultaneous estimates of LAVI (P = 0.002) and again CRP was a strong modifier of this relationship in adjusted analyses (P ≤ 0.01). Overall, at comparable LAVI levels, lung congestion was more pronounced in inflamed than in non-inflamed patients. Conclusion: In ESKD systemic inflammation is a modifier of the relationship between LAVI, an integrate measure of LV filling pressure, and lung water. For any given pressure, lung water is increased with higher CRP levels, likely reflecting a higher permeability of the alveolar-capillary barrier.
Inflammation is an amplifier of lung congestion by high lv filling pressure in hemodialysis patients: a longitudinal study / Torino, C.; Gargani, L.; Sicari, R.; Letachowicz, K.; Ekart, R.; Fliser, D.; Covic, A.; Siamopoulos, K.; Stavroulopoulos, A.; Massy, Z. A.; Fiaccadori, E.; Regolisti, G.; Bachelet, T.; Slotki, I.; Martinez-Castelao, A.; Coudert-Krier, M. -J.; Rossignol, P.; Hannedouche, T.; Wiecek, A.; Sarafidis, P.; Battaglia, Y.; Prohic, N.; Klinger, M.; Hojs, R.; Seiler-Mussler, S.; Lizzi, F.; Siriopol, D.; Balafa, O.; Shavit, L.; Loutradis, C.; Seidowsky, A.; Tripepi, R.; Mallamaci, F.; Tripepi, G.; Picano, E.; London, G. M.; Zoccali, C.. - In: JN. JOURNAL OF NEPHROLOGY. - ISSN 1121-8428. - 33:3(2020), pp. 583-590. [10.1007/s40620-019-00696-x]
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