Document Detail


Vascular access type and changes in inflammatory markers in incident dialysis patients: a pilot study.
MedLine Citation:
PMID:  19670170     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To determine the association between the initial hemodialysis (HD) vascular access type and short-term changes in inflammation markers. METHODS: This is a prospective, observational study in incident chronic kidney disease (CKD) (stages 4 and 5) patients receiving their first HD vascular access. Serum samples were obtained pre-access placement, and 1 week, and 1 month post-access insertion. Samples were tested for high sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6) using ELISA. Patients with known inflammatory states (infection, malignancy, connective tissue disorders, organ transplantation and those on immune modulating agents) were excluded. The hsCRP and IL-6 values were transformed into logarithmic scale. Chi-square analysis, independent and paired t-tests were performed where appropriate, and a two-way ANOVA with time as a repeated measure was also performed. Significance was determined at p=0.05. RESULTS: One-month follow-up data was obtained in 48 patients (arteriovenous fistula (AVF), n=10; tunneled catheter (TC), n=28; arteriovenous graft (AVG), n=10). A significant increase in both hsCRP (p <0.05) and IL-6 (p=0.02) occurring 1 week after TC insertion was observed. Elevation of the IL-6 levels appeared to be sustained 1 month after TC insertion, although this finding was not statistically significant (p=0.68), whereas the hsCRP levels returned to baseline within 1 month. After AVG insertion only the hsCRP levels rose significantly (p=0.01) after 1 week and returned to baseline within 1 month. In the AVF group, inflammatory markers did not change for any time period. CONCLUSIONS: In CKD patients, TC and AVG insertion result in a transient state of inflammation 1 week post-operatively, which is not observed after AVF surgery. Whether this is a persistent phenomenon after TC insertion requires a larger, longitudinal study.
Authors:
Mala Sachdeva; Oleksander Kovalchuk; Markus Bitzer; Michele Helene Mokrzycki
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The journal of vascular access     Volume:  10     ISSN:  1129-7298     ISO Abbreviation:  J Vasc Access     Publication Date:    2009 Jul-Sep
Date Detail:
Created Date:  2009-08-11     Completed Date:  2009-11-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100940729     Medline TA:  J Vasc Access     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  174-9     Citation Subset:  IM    
Affiliation:
Department of Medicine, Division of Nephrology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York 10467, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Arteriovenous Shunt, Surgical / adverse effects*
Biological Markers / blood
Blood Vessel Prosthesis Implantation / adverse effects*
C-Reactive Protein / metabolism*
Catheters, Indwelling / adverse effects*
Enzyme-Linked Immunosorbent Assay
Female
Humans
Incidence
Inflammation / blood,  etiology*
Inflammation Mediators / blood
Interleukin-6 / blood*
Kidney Failure, Chronic / epidemiology,  therapy*
Male
Middle Aged
Pilot Projects
Prospective Studies
Renal Dialysis*
Time Factors
Chemical
Reg. No./Substance:
0/Biological Markers; 0/IL6 protein, human; 0/Inflammation Mediators; 0/Interleukin-6; 9007-41-4/C-Reactive Protein

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