The Kind of Vascular Access Influences the Baseline Inflammatory Status and Epoetin Response in Chronic Hemodialysis Patients

Abstract

Background: Arteriovenous grafts (AVG) and tunneled permanent catheters (TPC) are increasingly being used in hemodialysis (HD) patients. However, their role in baseline inflammatory status has not been fully evaluated. Aim of the study was to evaluate the influence of the current kind of vascular access on the baseline inflammatory status, marked by serum C-reactive protein (CRP), and the response to epoetin therapy in a group of iron-replete HD patients, under steady clinical conditions, without evidence of acute infections and/or inflammatory diseases. Methods: We studied 79 patients who had been on bicarbonate HD for 8–410 months and were receiving epoetin therapy. They all had adequate iron stores and stable hemoglobin (Hb) levels. Exclusion criteria were fever, signs of infection, white blood cell count (WBC) >10 × 1,000/µl, for at least 4 weeks before study. 48 patients (group A) had arteriovenous fistula (AVF), 18 patients (group B) AVG, 13 patients (group C) TPC. CRP, Hb, transferrin saturation, serum ferritin, WBC, serum albumin, protein catabolic rate, Kt/V, and epoetin dose (U/kg body weight/week) were measured. CRP values were log-transformed to normalize the distribution. Results: Log-transformed CRP values among the 3 groups were significantly different: group A 1.81 ± 0.48; group B 2.12 ± 0.50, and group C 3.00 ± 0.25 (group A vs. B p < 0.003; group B vs. C p < 0.001; group A vs. C p < 0.0001). CRP and the epoetin dose were directly correlated (r = 0.519; p < 0.0001). The epoetin doses among the 3 groups were significantly different. Multiple regression analysis confirmed AVG and TPC as factors independently influencing CRP levels. Conclusions: AVG and TPC have a higher degree of chronic inflammation than AVF. The epoetin requirement is increased in TPC and AVG compared with AVF.

Biochemistry and Biomarkers of Inflamed Patients

“…ESA resistance is associated with infectious hospitalizations (79) and use of tunneled dialysis catheters (80). Attempts to reduce exposure to bacterial products by improving the quality of water systems have been found to increase ESA sensitivity in groups of dialysis patients, either by providing ultrapure dialysate (31) or even by upgrading the plumbing in an existing dialysis unit (33).…”

Pentoxifylline decreases serum levels of tumor necrosis factor alpha, interleukin 6 and C-reactive protein in hemodialysis patients: results of a randomized double-blind, controlled clinical trial

“…Variables related to HD procedure that could potentially affect inflammation results [29][30][31] were controlled in the current study, as all patients were treated with the same dialysis solution, vascular access and length of HD session. Although to a significantly lesser extent compared with bioincompatible membranes, cellulose triacetate membranes may still activate complement and cause cytokine production, neutropenia, fagocytotic and oxygen species production alterations [29].…”

Vascular Access for Hemodialysis

“…[88]. It has been shown that patients with AVGs and TCs have higher levels of chronic inflammation than those with AVFs, and increased requirements in epoetin [89]. In our previous work with 149 hemodialysis patients who had undergone 202 vascular access procedures (177 Cimino-Brescia fistulae and 25 PTFE grafts) we found that the Cimino-Brescia fistula was used as the first choice of vascular access in all patients, except one in the elderly group.…”