Chronic Induction of C-Reactive Protein by Hemodialysis, but Not by Peritoneal Dialysis Therapy

Haubitz, Marion; Brunkhorst, Reinhard; Wrenger, Eike; Froese, P.; Schulze, Matthias; Koch, Karl-Martin

doi:10.1177/089686089601600213

Cited by 97 publications

(47 citation statements)

References 24 publications

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“…47 This assertion is further endorsed by the conflicting data on proinflammatory cytokine induction during or after dialysis. [86][87][88] Additionally, in a small multicenter study of patients assigned to different renal replacement modalities (hemofiltration or hemodialysis), no difference was observed in levels of inflammatory markers between treatment modalities, although levels in both groups were elevated compared with healthy controls. 89…”

Section: Reduced Kidney Function and Dialysismentioning

confidence: 96%

Causes and consequences of inflammation on anemia management in hemodialysis patients

Chawla

Krishnan

2009

Hemodialysis International

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Inflammation is common among hemodialysis patients, and evidence is accumulating to suggest that inflammation is a major contributor to morbidity and mortality. Several factors have been suggested as potential causes of inflammation, including infections and the atherosclerosis process, as well as etiologies directly related to kidney disease such as reduced renal function and dialysis. Among several inflammatory biomarkers investigated, serum C-reactive protein (CRP) is the most widely used. In hemodialysis patients, raised CRP levels have been shown to be predictive of cardiovascular events, hospitalization, and all-cause and cardiovascular mortality. Elevated CRP levels may correlate with comorbidities and intercurrent events, all of which may impact the response to erythropoiesis-stimulating agents (ESAs) and lead to higher ESA doses. Most dialysis facilities do not routinely measure CRP, despite recommendations by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative. Regular measurement of CRP levels may help providers to understand change in ESA dosing and identify patients at risk for cardiovascular events. This review explores the inter-relationships between inflammation, CRP levels, and anemia management in patients receiving hemodialysis.

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Section: Reduced Kidney Function and Dialysismentioning

confidence: 96%

Causes and consequences of inflammation on anemia management in hemodialysis patients

Chawla

Krishnan

2009

Hemodialysis International

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“…Levels of CRP in renal patients are possibly higher than in the general population. The reasons have not been identified, but the uremic state or the renal disease itself may be the cause [9]. Haubitz et al [9] found that these high levels are even higher among HD patients relative to PD or pre-dialysis patients.…”

Section: Discussionmentioning

confidence: 99%

“…The reasons have not been identified, but the uremic state or the renal disease itself may be the cause [9]. Haubitz et al [9] found that these high levels are even higher among HD patients relative to PD or pre-dialysis patients. The elevation was confirmed by the increased levels after HD was initiated in 8 patients.…”

Section: Discussionmentioning

confidence: 99%

“…Although the relationships among CRP level, serum albumin, and morbidity and mortality in dialysis patients have been accepted, the cause for CRP elevation and the inflammatory mechanism causing the increase in mortality remain to be determined. End-stage renal disease (ESRD) patients have higher CRP plasma levels than does a healthy population [9], and HD patients have even higher levels than do PD or pre-dialysis patients [9,10]. This difference has been attributed to the HD process as a stimulus for inflammation.…”

Section: Introductionmentioning

confidence: 99%

“…This difference has been attributed to the HD process as a stimulus for inflammation. In addition, the use of "less biocompatible" membranes [9,11] and techniques associated with retrofiltration [12] cause a chronic inflammatory response.…”

Section: Introductionmentioning

confidence: 99%

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A Comparative Study of C-Reactive Protein Plasma Levels in Patients on Hemodialysis and Peritoneal Dialysis

Mj¹,

Hevia²,

Bajo³

et al. 2001

Hemodialysis International

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I n dialysis patients, C-reactive protein (CRP), a wellrecognized marker of inflammation, predicts mortality. Higher levels have been described in hemodialysis (HD) patients as compared with peritoneal dialysis (PD) patients. Our aim was to determine, based on CRP plasma levels, the degree of inflammation in HD patients using low-permeability polysulfone membranes and relatively pure dialysate, and that in PD patients. A secondary objective was to study factors associated with hypoalbuminemia and inflammation in both populations.We studied 69 stable patients on dialysis (32 on HD and 37 on PD). The mean age was 69.9 ± 8.2 years, and the mean time on dialysis was 27 months. The two populations were comparable for overall and cardiovascular comorbidities. Nephelometry was used to measure CRP plasma levels (normal levels < 0.6 mg/dL). The Kt/V urea , corrected for residual renal clearance, and the equivalent of protein nitrogen appearance (PNA) were also calculated.Of the patients studied, 53% showed CRP plasma levels higher than 0.6 mg/dL; in 36%, the levels were higher than 1 mg/dL. No significant differences in these percentages were noted between the two dialysis groups. Patients with CRP levels higher than 1 mg/dL showed lower serum albumin, iron, hemoglobin, and transferrin levels, and higher ferritin values and leukocyte counts. Under logistic regression analysis, CRP levels higher and lower than 1 mg/dL were significantly associated with serum albumin [p = 0.01; odds ratio (OR): 0.15], iron (p = 0.006; OR: 0.96), transferrin (p = 0.004; OR: 0.97), and hemoglobin (p = 0.02; OR: 0.67). Serum albumin levels were significantly lower in PD patients. Under regression analysis, serum albumin levels correlated with cholesterol (r: 0.25; p = 0.04), serum iron (r: 0.5; p = 0.0001), transferrin (r: 0.3; p = 0.015), ultrafiltration capacity (r: 0.42; p = 0.008), and CRP values above 0.6 mg/dL (r: -0.65; p = 0.001).In conclusion, the frequent elevation of CRP plasma levels observed in both HD and PD patients suggests the pres-ence of a silent inflammatory state. Hemodialysis performed with biocompatible, low-permeability membranes is not associated with higher CRP plasma levels than those seen in PD. In both groups, hypoalbuminemia is related to CRP level. Levels of serum albumin, slightly lower in PD patients, are also related to peritoneal ultrafiltration capacity.

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Comparison of atherosclerosis and atherosclerotic risk factors in patients receiving hemodialysis and peritoneal dialysis

Cengiz¹,

Dolu²

2007

Dialysis & Transplantation

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BACKGROUND: Although some studies have found that myocardial infarction and cerebrovascular disease are more common in patients receiving continuous ambulatory peritoneal dialysis (CAPD) than in patients receiving hemodialysis (HD), the results of other studies have not supported these findings. Studies comparing patients receiving HD with patients receiving CAPD have had conflicting results.OBJECTIVE: The aims of this study were to compare the atherosclerotic changes in CAPD and HD patients and to assess which factors might be responsible for atherosclerosis in dialysis patients.METHODS: Enrolled in the study were 33 patients receiving HD, 32 patients receiving CAPD, and 33 controls for a total of 98 participants. Serum triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein, lipoprotein (a) (Lp[a]), apolipoprotein A-I, apolipoprotein B (Apo B), apolipoprotein E (Apo E), albumin, high-sensitivity C-reactive protein (hs-CRP), fibrinogen, intact parathyroid hormone (iPTH), and ferritin levels were obtained from all patients. Carotid intima-media thickness (CIMT) and plaque number were calculated using B-mode ultrasonography.RESULTS: Serum TG, Lp(a), Apo B, hs-CRP, fibrinogen, ferritin, and iPTH levels were significantly higher in the dialysis groups than in the control group; whereas HDL, Apo E, and albumin levels were decreased (p Ͻ .05); the others were same in the all groups. However, there was no difference between the HD and CAPD groups in the other lipid parameters except Lp(a) (p Ͻ .05). CIMT and plaque number of the patients treated with dialysis were higher than those of the control group (p Ͻ .01), but were not significantly different between the 2 dialysis groups (p Ͼ .05). CIMT and plaque number were positively correlated with age (r ϭ 0.43; p Ͻ .05) and hs-CRP level (r ϭ 0.40; p Ͻ .05) and negative correlated with serum albumin and hs-CRP levels (r ϭ Ϫ0.37, p Ͻ .05; and r ϭ Ϫ0.25; p Ͻ .05, respectively).CONCLUSIONS: Serum Apo B and Lp(a) levels were higher in the CAPD patients than in the HD patients. CIMT and plaque number were positively correlated with age and hs-CRP level and negatively correlated with serum albumin and hs-CRP levels.

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Chronic Induction of C-Reactive Protein by Hemodialysis, but Not by Peritoneal Dialysis Therapy

Cited by 97 publications

References 24 publications

Causes and consequences of inflammation on anemia management in hemodialysis patients

Causes and consequences of inflammation on anemia management in hemodialysis patients

A Comparative Study of C-Reactive Protein Plasma Levels in Patients on Hemodialysis and Peritoneal Dialysis

Comparison of atherosclerosis and atherosclerotic risk factors in patients receiving hemodialysis and peritoneal dialysis

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