Endotoxemia is associated with acute coronary syndrome in patients with end stage kidney disease

Chien-Chin Hsu, Tsui-Shan Wei, Chien-Cheng Huang, Yi-Ming Chen

Cardiovascular disease is the major cause of death in patients with end-staged kidney disease (ESRD). Most ESRD patients have systemic inflammation, and increasing the risk of cardiovascular event. Endotoxin derived from lipopolysaccharide of Gram negative bacteria accounts for 70% of intestinal bacteria, leading to release of proinflammatory cytokines and negative cardiovascular effect. Impaired intestinal barriers have been found in some ESRD patients, and may lead to bacteria translocation from gastrointestinal tract. We aim to investigate the association of endotoxemia in ESRD patients and acute coronary syndrome (ACS). We collected serum from adult ESRD patients who presented to emergency department (ED) with ACS (30 patients) or without ACS (30 patients) as control from 11/01/2013 to 10/31/2014 in Chi Mei Medical Center in southern Taiwan. Clinical information and lab data were collected. We measured the endotoxin level of the serum of ESRD patients with or without ACS. We used real-time 16S rDNA PCR to detect possible bacteria in the blood of the patients. The endotoxin level of ESRD patients with ACS (0.49 (±0.12) EU/mL) was significantly higher than that of ESRD patients without ACS (0.1 ± 0.08) (p < 0.01). However, the endotoxin level was not correlated with the troponin-I level (r = -0.12). Although endotoxin level was higher in ESRD patients with ACS, bacteria were not detected in the serum by using the real-time 16S rDNA PCR. Endotoxin in ESRD patients with ACS was significantly higher than that without ACS. The result suggested that endotoxemia may have a contributory role to cardiovascular disease in ESRD patients.