Intercurrent clinical events are predictive of plasma C-reactive protein levels in hemodialysis patients.
BACKGROUND
In chronic hemodialysis (HD) patients, the repetitive induction of the acute phase response (APR) may induce a chronic micro-inflammatory state, leading to various long-term complications.


METHODS
The present prospective study was designed to assess the alterations in the APR in 74 patients who were randomized to HD with a high-flux polysulfone (PS; F 60S), a super-flux PS (F 500S), or a super-flux cellulosic tri-acetate (CTA and CTA with filtered dialysate, CTA(f)) dialyzer. Blood samples collected at the start of the study and after twelve weeks were analyzed for interleukin-6 (IL-6) and C-reactive protein (CRP). In addition to the microbiological quality of the dialysate, the appearance of a "clinical event" was assessed.


RESULTS
At baseline, mean IL-6 levels were within the reference range whereas mean CRP levels were slightly elevated. Mean values did not change after 12 weeks of HD with either modality. After subdividing the patients in quartiles with increasing change in plasma CRP, 23.0% of the patients showed a change of more than 8.0 mg/L. In a multiple regression analysis, CRP levels appeared to be independent of the degree of dialysate contamination, the material and the flux characteristics of the devices. In fact, the variable "clinical events" was the only significant predictor of the plasma CRP levels (P < 0.001).


CONCLUSIONS
Based on these results, both PS and CTA super-flux dialyzers appear safe for clinical use. Whether changes in CRP values, which are associated with intercurrent clinical events, influence the long-term prognosis of chronic HD patients remains to be established.
Department of Nephrology, Medical Centre Alkmaar, The Netherlands. avantellingen@worldmail.nl
Anne
A
van Tellingen
Muriel P C
MP
Grooteman
Margreet
M
Schoorl
Piet C M
PC
Bartels
Marianne
M
Schoorl
Tjeerd
T
van der Ploeg
Piet M
PM
ter Wee
Menso J
MJ
Nubé
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism*; D002408:Catheters, Indwelling; D015169:Colony Count, Microbial; D015314:Dialysis Solutions; D005260:Female; D005500:Follow-Up Studies; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000382:microbiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation*
D015314:Dialysis Solutions; D015850:Interleukin-6; D002097:C-Reactive Protein