Possible involvement of macrophage-colony stimulating factor in the pathogenesis of cardiac dysfunction in hemodialysis patients

In patients with end stage renal disease on hemodialysis (HD), left ventricular (LV) function is frequently impaired. However, the mechanism of the LV dysfunction is totally unknown. It has been suggested that overproduction of nitric oxide induced by inflammatory cytokines may contribute to the LV dysfunction in some diseased states. In this study, we examined whether inflammatory cytokines play a role in the altered LV function in HD patients. The plasma concentrations of 5 major inflammatory cytokines, including interleukin (IL)-1α, IL-1β, IL-6, tumor necrosis factor-α, and macrophage-colony stimulating factor (M-CSF) were measured by enzyme immunoassay with horseradish peroxidase in 18 consecutive patients on HD and in 16 control subjects. Then, we examined the relationship between plasma concentrations of M-CSF and LV ejection fraction (EF) on echocardiography. Among the inflammatory cytokines examined, only the plasma concentrations of M-CSF were significantly elevated in patients on HD as compared to the control subjects. There was no significant change in the M-CSF concentrations before and after HD. Furthermore, there was a significant negative correlation between the plasma concentrations of M-CSF and LVEF. These results suggest that elevated levels of plasma M-CSF may exist prior to the development of LV dysfunction observed in HD patients.