Document Detail

Non-infected hemodialysis catheters are associated with increased inflammation compared to arteriovenous fistulas.
MedLine Citation:
PMID:  19675528     Owner:  NLM     Status:  MEDLINE    
Although hemodialysis catheters predispose to infection which, in turn, causes inflammation, we studied whether they induce inflammation independent of infection. We compared the level of the inflammatory marker C-reactive protein (CRP) in maintenance hemodialysis patients, comparing those dialyzed using a non-infected catheter to those using arteriovenous fistulas. All incident patients had catheters and fistula placement at dialysis initiation. In 35 patients the fistulas matured, the catheters were removed and the patients were evaluated at 6 months (catheter-fistula). These results were compared to 15 patients in whom the fistula did not mature and catheter use persisted for 6 months (catheter-catheter). There was a significant 82% reduction in the CRP level in the catheter-fistula group but a 16% increase in the catheter-catheter group at 6 months. The changes in CRP did not differ by gender, diabetes status, or by race, and was not correlated with a change in phosphorus, age, or urea reduction ratio at 1 month following hemodialysis initiation. Decreased CRP was associated with increased hemoglobin and albumin. Patients with persistent fistula use from dialysis initiation through 6 months had consistently low CRP levels over that time period. Our study shows that catheters might contribute to increased inflammation independent of infection, and supports avoidance of catheters and a timely conversion to fistulas with catheter removal.
Stuart L Goldstein; T Alp Ikizler; Michael Zappitelli; Douglas M Silverstein; Juan C Ayus
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Publication Detail:
Type:  Journal Article     Date:  2009-08-12
Journal Detail:
Title:  Kidney international     Volume:  76     ISSN:  1523-1755     ISO Abbreviation:  Kidney Int.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-30     Completed Date:  2010-04-16     Revised Date:  2013-09-12    
Medline Journal Info:
Nlm Unique ID:  0323470     Medline TA:  Kidney Int     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1063-9     Citation Subset:  IM    
Baylor College of Medicine, Houston, Texas, USA.
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MeSH Terms
Arteriovenous Shunt, Surgical / adverse effects,  methods*
C-Reactive Protein / metabolism
Catheterization / adverse effects*
Catheters, Indwelling / adverse effects*
Inflammation / etiology*
Longitudinal Studies
Middle Aged
Renal Dialysis / adverse effects,  methods*
Treatment Outcome
Grant Support
Reg. No./Substance:
9007-41-4/C-Reactive Protein
Comment In:
Kidney Int. 2009 Nov;76(10):1025-6   [PMID:  19876056 ]
Kidney Int. 2010 May;77(10):930-1; author reply 931   [PMID:  20431579 ]
Kidney Int. 2010 Oct;78(7):709; author reply 709-10   [PMID:  20842153 ]

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