Whether CRP is just a marker of overall inflammatory state or a direct mediator of LVH is currently uncertain. Based on LVMI and RWT, four patterns of cardiac effect astrocytes geometry were recognized. Abnormal cardiac geometry is associated with CV events in patients with CKD. In the current study, the presence of both concentric and eccentric hypertrophy was associated with elevated levels of hs-CRP and inflammatory cytokines. Circulating IL-6 was associated with the presence of both concentric and eccentric hypertrophy. In two hypertensive rat models, Kurdi et al. showed that IL-6 and leukemia inhibitory factor contributed to angiotensin II-dependent LVH. In vitro studies show that IL-6 mediates cardiac myocyte hypertrophy by an autocrine pathway and fibroblast proliferation by a paracrine pathway. In the current study, low serum albumin was associated with LVMI as well as with the presence of eccentric hypertrophy. A strong association between serum albumin and LV dilation has been reported in end-stage renal disease patients. The link between serum albumin and cardiac geometry could be a reflection of underlying inflammation as well as other associated comorbidities such as protein energy wasting. Heart failure may be due to systolic or diastolic dysfunction, or both. In the present study, ejection fraction was negatively associated with hs-CRP and IL-6. The contractile function of isolated cardiac myocytes is modulated by cytokines through activation of the neutral sphingomyelinase pathway and by NO-mediated blunting of ��-adrenergic signaling. Pro-inflammatory cytokines may also promote diastolic heart failure through down-regulation of diastolic calcium reuptake by sarcoplasmic reticulum. However, in our study only hsCRP was associated with an increased risk for diastolic dysfunction. The cross-sectional associations reported in this study should be interpreted with caution. Cytokines are pleiotropic in their actions, and exhibit interactive cascades in which they induce or repress their own synthesis as well as that of other cytokines and cytokine receptors. An important component of the inflammatory cascade is the acute-phase response, which is regulated by cytokines such as IL-6. In the present study as well, IL-6 emerged as a strong and independent predictor of unfavorable cardiac geometry. A number of studies have demonstrated that single measures of various inflammatory biomarkers at baseline are important determinants of subsequent adverse outcomes in subjects with kidney disease. In a study involving 62 subjects without kidney disease, single measures of hs-CRP, TNF-��, IL-8, and soluble TNF receptor I and II accurately reflected the inflammatory status over a 4�C6-month period. However, intra-individual variation in inflammatory biomarkers is also reported in subjects with and without kidney disease. In the Mapping of Inflammatory Markers in Chronic Kidney Disease Study, inflammatory markers were measured over 3 months in 228 hemodialysis patients. Baseline CRP level was highly correlated with time-averaged CRP as well as with the median of serial CRP values. However, in the multivariate Cox model, median CRP level was associated more strongly with mortality than a single baseline value, indicating that serial CRP values over time is superior in estimation of the patient’s risk profile.