Effect of a single hemodialysis session on inflammatory markers

Abstract

Inflammation is a common feature of end-stage renal disease. Although there is evidence for hemodialysis (HD)-induced inflammatory process, the effect of a dialysis session on changes in inflammatory markers is still unclear. Seventeen patients of end-stage renal disease on maintenance HD along with 20 age-matched and sex-matched healthy controls were recruited after informed consent. C-reactive protein (CRP) and lipoprotein-associated phospholipase A2 (LpPLA2) activity were measured in the study and control groups. Intradialytic in CRP and LpPLA2 were studied. Comparison of pre-HD vs. the control group and predialytic and postdialytic values was performed using the Mann-Whitney U test and Wilcoxon's test, respectively. Statistical evaluation of intradialytic changes in inflammatory markers was performed using Friedman's test. Hemodialysis patients had higher CRP levels compared with controls (P=0.001). Post-HD LpPLA2 activity (n=17) was higher (P=0.039) compared with the pre-HD activity. Intradialytic changes in inflammatory markers showed a significant increase (P=0.012) in LpPLA2 activity (n=7), while no change (P=0.133) was observed in CRP levels (n=17). Evidence on the pro-inflammatory state being initiated by dialysis is provided by increased LpPLA2 activity. This may add to the atherogenic mileu and cause endothelial dysfunction in this high-risk group. Drugs that inhibit the LpPLA2 pathway have been developed and may be effective in these patients.

Effects of Lipoprotein-Associated Phospholipase A2 on Arginase/Nitric Oxide Pathway in Hemodialysis Patients

“…18 Two previous studies in uremic patients undergoing various dialysis procedures demonstrated that PAF-AH activity in the plasma of patients with stage 3-4 chronic kidney disease was significantly higher than control subjects. 19,20 In a recent study, Bitla et al 6 reported that Lp-PLA2 activity is increased at the end of dialysis session and suggested that HD therapy produces an increase in Lp-PLA2 activity. In contrast, Milionis et al 19 demonstrated that PAF-AH activity was not different before and after the dialysis procedure.…”

“…CRP is a marker of systemic inflammation, while Lp-PLA2 represents a specific marker for local vascular inflammation and endothelial dysfunction, suggesting that both have different pathophysiological mechanisms and providing a plausible explanation for not finding a correlation between these two markers. 6 Dialysis-induced local inflammation might be able to increase the Lp-PLA2 production as well as CRP production. CRP might not be the ideal marker to study inflammatory changes as a result of dialysis; however, Lp-PLA2 serves as a better biochemical marker to determine the effects of dialysis on inflammatory markers.…”

“…CRP might not be the ideal marker to study inflammatory changes as a result of dialysis; however, Lp-PLA2 serves as a better biochemical marker to determine the effects of dialysis on inflammatory markers. 6,7 In this study, serum arginase activity was evaluated as another marker of CHD in HD patients. We found increased arginase activity in HD patients compared with control subjects.…”

“…5 Recently, lipoprotein-associated phospholipase A2 (Lp-PLA2) was proposed as a novel inflammatory and endothelial dysfunction marker in HD patients. 6,7 Lp-PLA2 is a potentially useful plasma biomarker associated with cardiovascular disease. 8,9 The enzyme, also known as plasma platelet-activating factor acetylhydrolase (PAF-AH), is a Ca þ2 independent enzyme and has two prominent biological activities.…”

Effects of intradialytic exercise on systemic cytokine in patients with chronic kidney disease

“…1 Furthermore, chronic hemodialysis (HD) can stimulate the intracellular pattern of inflammatory mediators. 1,3 As a result, the development of a chronic inflammatory state is associated with certain conditions such as muscle atrophy, malnutrition, chronic infections and atherosclerotic processes, and major causes of morbidity and mortality. 4 Cytokines are glycoproteins with low molecular weight, secreted in response to antigens, danger signals or others chemical messengers and that regulate many immunological aspects across pro-or anti-inflammatory activities.…”