Elevated Serum Levels of C-Reactive Protein in Hemodialysis Patients

Docci, D; Bilancioni, R; Buscaroli, Andrea; Baldrati, L; C, Capponcini; Mengozzi, Silvia; Turci, F; Feletti, C

doi:10.1159/000186176

Cited by 57 publications

(40 citation statements)

References 8 publications

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“…Although 29% of hemodialyzed and 56% of uremic patients had elevated CRP levels, there was no correlation with the levels of circulating IL-6. Our observation is in agreement with the recent data reported by Docci et al [30] who showed that mean levels of CRP were elevated in the sera of hemodia lyzed patients. Recently, an increased level of serum amy loid A (SAA) was noticed during the dialysis session [31], Although IL-6 triggers the production of SAA, this ob served enhancement cannot be related to IL-6 since the levels of this cytokine remained unchanged during the dialysis session.…”

Section: Discussionsupporting

confidence: 94%

Serum Interleukin-6 in Long-Term Hemodialyzed Patients

Cavaillon

Poignet²,

Fitting

et al. 1992

Nephron

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The generation of compounds such as interleukin 1 (IL-1), tumor necrosis factor alpha (TNFα), and the possible encounter of circulating cells with endotoxin (LPS) have been demonstrated during hemodialysis. All these factors are able to induce the production of IL-6 by human monocytes. Anaphylatoxins can be generated following complement activation by cellulosic membrane dialysis. C5a is known to potentiate the LPS-induced production of IL-1 and TNFα, and we established that recombinant human C5a was able to act synergistically with LPS in the induction of IL-6 by human monocytes. We investigated whether IL-6 could be detected in the serum of long-term hemodialyzed and uremic patients. Using the very sensitive 7TD1 cell line bioassay, we demonstrated that circulating IL-6 activity was present in the serum of all 14 tested patients, whereas it was occasionally present in normal sera. The presence of serum IL-6 was confirmed using an anti-IL-6 antibody and a specific ELISA (109 ± 36 pg/ml). Most patients had a reproducible level of IL-6 activity throughout a period of 10 days. The dialysis session did not significantly modify these levels and patients had similar serum IL-6 activity at the start, during or the at end of the dialysis session. The different parameters of the dialysis session (i.e. standard or filtrated dialyzates, complement-activating or nonactivating membranes) did not significantly influence the levels of IL-6. Elevated levels of IL-6 were also observed in uremic patients compared to normal donors, although significantly lower than in hemodialyzed patients (p = 0.001). Since IL-6 is a hepatocyte-stimulating mediator, we searched for a correlation with C-reactive protein (CRP). Although 4/14 hemodialyzed patients and 5/9 uremic patients had high CRP values, there was no correlation with IL-6 levels. Whether or not the hemodialysis itself or the pathology is responsible of the elevated level of IL-6 is discussed.

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Section: Discussionsupporting

confidence: 94%

Serum Interleukin-6 in Long-Term Hemodialyzed Patients

Cavaillon

Poignet²,

Fitting

et al. 1992

Nephron

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“…Inflammation is a highly prevalent condition among CKD patients. Crosssectional studies have shown that 30-50% of nondialysis (Ortega et al, 2002) and dialysis (Docci et al, 1990;McIntyre et al, 1997) patients present serologic evidence of an activated inflammatory response with elevated serum concentration of C-reactive protein (CRP). Our group has recently reported increased REE in nondialysis patients with CRP40.5 mg/dl (Avesani et al, 2004a).…”

Section: Introductionmentioning

confidence: 99%

Resting energy expenditure and its determinants in hemodialysis patients

et al. 2006

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Objective: Chronic kidney disease is associated with several metabolic disturbances that can affect energy metabolism. As resting energy expenditure (REE) is scarcely investigated in patients on hemodialysis (HD) therapy, we aimed to evaluate the REE and its determinants in HD patients. Design: Cross-sectional study. Setting: Dialysis Unit of the Nephrology Division, Federal University of São Paulo, Brazil. Subjects: The study included 55 patients (28 male, 41.4712.6 years old) undergoing HD therapy thrice weekly for at least 2 months, and 55 healthy individuals pair matched for age and gender. Subjects underwent fasting blood tests, as well as nutritional assessment, and the REE was assessed by indirect calorimetry. Results: REE of HD patients was similar to that of pair-matched controls (13797272 and 14407259 kcal/day, respectively), even when adjusted for fat-free mass (P ¼ 0.24). REE of HD patients correlated positively with fat-free mass (r ¼ 0.74; Po0.001) and body mass index (r ¼ 0.37; Po0.01), and negatively with dialysis adequacy (r ¼ À0.46; Po0.001). No significant univariate correlation was found between REE and age, dialysis vintage, serum creatinine, urea, albumin, bicarbonate, parathyroid hormone (PTH) or high-sensitivity C-reactive protein (CRP). In the multiple linear regression analysis, using REE as dependent variable, the final model showed that besides the well-recognized determinants of REE such as fat-free mass and age, PTH and CRP were the independent determinants of REE in HD patients (R 2 ¼ 0.64).

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“…Also, hs-CRP levels correlate with the length of dialysis in ESRD patients alluding to a strong involvement of the protein in the inflammatory process [7]. This is important given recent reports linking altered hs-CRP levels with cardiac hypertrophy and increased arterial stiffness [5, 6, 8].…”

Section: Introductionmentioning

confidence: 99%

Adiponectin and Cardiovascular Remodeling in End-Stage Renal Disease and Co-Morbid Diabetes Mellitus

Karakitsos

Groot

Patrianakos³

et al. 2006

Am J Nephrol

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Objectives and Methods: Altered plasma high-sensitivity C-reactive protein (hs-CRP) and adiponectin (ADP) may contribute to increased vascular inflammation and accelerated atherosclerosis in patients with end-stage renal disease (ESRD) and co-morbid diabetes. Common carotid artery intima-media thickness (CCA-IMT) and atherosclerotic plaque occurrence, left-ventricular mass index (LVMI), and pulse wave velocity of the proximal aorta (PWVr) were determined by ultrasound imaging in 120 ESRD (55 diabetic) patients, and 83 age-, sex-, and blood pressure-matched controls. Also, plasma levels of ADP and hs-CRP were determined and their relationships with the above cardiovascular alterations were analyzed. Results: LVMI, PWVr, CCA-IMT and atherosclerotic plaque occurrence were all increased in ESRD patients compared to controls (all p < 0.001). LVMI (p < 0.05), PWVr (p < 0.001), CCA-IMT (p < 0.001) and atherosclerotic plaque occurrence (p < 0.001) were increased in diabetic compared to nondiabetic ESRD patients. Hs-CRP levels were increased and ADP levels were decreased in diabetic compared to nondiabetic ESRD patients (both p < 0.001). ADP levels correlated inversely with hs-CRP (r = –0.473, p < 0.0001) in ESRD patients. Hs-CRP was positively correlated with LVMI (r = 0.365, p < 0.0001), PWVr (r = 0.42, p < 0.0001) and CCA-IMT (r = 0.18, p = 0.047) while ADP inversely correlated with PWVr (r = –0.263, p = 0.0035) and CCA-IMT (r = –0.207, p = 0.022) in ESRD patients. Conclusion: The present results indicate diabetic disease-specific alterations in the biochemical parameters of hs-CRP and ADP in ESRD patients. The above biochemical parameters were intimately linked to the cardiovascular measurements of LVMI, PWVr and CCA-IMT in patients with ESRD and co-morbid diabetes mellitus.

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Elevated Serum Levels of C-Reactive Protein in Hemodialysis Patients

Cited by 57 publications

References 8 publications

Serum Interleukin-6 in Long-Term Hemodialyzed Patients

Serum Interleukin-6 in Long-Term Hemodialyzed Patients

Resting energy expenditure and its determinants in hemodialysis patients

Adiponectin and Cardiovascular Remodeling in End-Stage Renal Disease and Co-Morbid Diabetes Mellitus

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