Mala Sachdeva, Markus Bitzer, Michele H. Mokrzycki. Medicine, Montefiore Medical Center, Bronx, NY; Medicine, Albert Einstein College of Medicine, Bronx, NY
The relationship of vascular access and inflammation in hemodialysis (HD) patients is unknown. The purpose of this study was to determine the effect of vascular access type on markers of inflammation (IL-6 and hs-CRP).
Methods: This is a prospective, observational study in incident HD patients. Serum samples were obtained pre-access placement, and 1-week and 1- month post-access. Samples were tested for hs-CRP and IL-6 by ELISA. Patients with inflammatory states (infection, malignancy, connective tissue disorders, HIV, renal transplants, and those on immuno-modulating agents) were excluded. hs-CRP and IL6 were transformed into logarithmic scale. Paired t-tests within individual access groups and 2-way ANOVA with time as a repeated measure were performed. Significance was determined at p=0.05 Results: One-month follow up data was obtained in 49 patients (Arteriovenous Fistula [AVF], n=10; Tunneled Catheter [TC], n=29; Arteriovenous Graft [AVG], n=10). There was a rise in hs-CRP in both the AVG and TC groups in the pre- to 1-week post-access period (p =0.010 and p=0.045), which declined within one month towards the baseline CRP values (p<0.001 and p=0.020). CRP was higher at 1 wk in the AVG group as compared to the TC and AVF groups, (p=0.01 and p=.005). There was also a rise in IL-6 within the 1-week post-access period in the TC and AVG groups (p=0.02 and p=0.11). In the TC group, the elevated IL-6 values appeared to be sustained through the 1-month period, although this was not significant (p=0.68). In the AVF group, the CRP and IL-6 values did not significantly change over time.
Conclusion: We report a state of inflammation following TC and AVG insertion which is not observed after AVF creation. Whether this is a transient or a persistant phenomenon requires further study.
Presented at the American Society of Nephrology Renal Week 2007, San Francisco, California