C-reactive protein in patients on chronic hemodialysis with different techniques and different membranes.
In hemodialysis patients, C-reactive protein (CRP), an acute-phase reactant, is a sensitive and independent marker of malnutrition, anemia, and cardiovascular mortality. The aim of the present study was to evaluate CRP levels in plasma samples from long-term hemodialysis patients on different extracorporeal modalities and dialyzed with different membranes, at baseline and after 6 months. Two hundred and forty-seven patients were recruited in eight hospital-based centers. All patients had been on their dialytic modality for at least 3 months and were prospectively followed in their initial dialytic modality for 6 months. Patients were treated with conventional bicarbonate dialysis (N = 127) or hemodiafiltration (N = 120). Patients treated with conventional bicarbonate dialysis were dialyzed with different membranes: Cuprophane (N = 51), low-flux cellulose modified membrane (N = 37) and synthetic membranes (N = 39). Hemodiafiltration was performed in post-dilution mode with polysulfone (N = 66) and polyacrylonitrile (N = 54) membranes. Analysis of baseline CRP values in the clinically stable patients showed that an unexpectedly high proportion (47%) of the patients had CRP values higher than 5 mg/l (upper limit in normal subjects). The mean +/- S.D. CRP values were significantly higher (P < 0.05) in hemodiafiltration with infusion volumes < 10 l per session (14.6+/-3.1 mg/l) than in standard hemodialysis (5.1 +/- 2.1 mg/l) and hemodiafiltration with infusion volumes > 20 l per session (4.9 +/- 2.1 mg/l). These values did not significantly change after 6 months of follow-up. Concerning the membranes, the highest levels of CRP were observed in patients dialyzed with Cuprophane with a significant increase from 15.1 +/- 3.6 to 21.2 +/- 3.1 mg/l after 6 months (P < 0.05); a significant reduction of CRP levels was observed in patients dialyzed with polysulfone in the same follow-up period (from 13.5 +/- 2.9 to 8.1 +/- 2.4 mg/l; P < 0.05). The CRP increase following low volume HDF can be related to back-filtration of bacterial derived contaminants.; moreover, an important effect on CRP of the hemodialysis membrane is observed and new synthetic membranes can be used to decrease these levels.
Panichi
V
V
Department of Internal Medicine, University of Pisa, Italy. vpanichi@med.unipi.it
Rizza
G Manca
GM
Taccola
D
D
Paoletti
S
S
Mantuano
E
E
Migliori
M
M
Frangioni
S
S
Filippi
C
C
Carpi
A
A
D000180:Acrylic Resins; D002097:C-Reactive Protein / Q000032:analysis / Q000378:metabolism*; D002482:Cellulose / Q000031:analogs & derivatives; D003430:Cross-Sectional Studies; D017583:Hemodiafiltration; D015312:Hemodialysis Solutions / Q000737:chemistry; D006801:Humans; D008137:Longitudinal Studies; D008567:Membranes, Artificial; D011108:Polymers; D011749:Pyrogens / Q000302:isolation & purification; D006435:Renal Dialysis / Q000379:methods; D051437:Renal Insufficiency / Q000097:blood / Q000628:therapy*; D013450:Sulfones
D000180:Acrylic Resins; D015312:Hemodialysis Solutions; D008567:Membranes, Artificial; D011108:Polymers; D011749:Pyrogens; D013450:Sulfones; C010504:polyacrylonitrile; C017662:polysulfone P 1700; D002482:Cellulose; D002097:C-Reactive Protein; C009865:cuprammonium cellulose