The kind of vascular access influences the baseline inflammatory status and epoetin response in chronic hemodialysis patients.
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 x 1,000/microl, 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.
Movilli
Ezio
E
Chair and Division of Nephrology, Spedali Civili and University of Brescia, University of Brescia, Brescia, Italy. eziomov@libero.it
Brunori
Giuliano
G
Camerini
Corrado
C
Vizzardi
Valerio
V
Gaggia
Paola
P
Cassamali
Silvia
S
Scolari
Francesco
F
Parrinello
Giovanni
G
Cancarini
Giovanni C
GC
D000368:Aged; D000704:Analysis of Variance; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D002097:C-Reactive Protein / Q000378:metabolism*; D016009:Chi-Square Distribution; D002908:Chronic Disease; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000378:metabolism*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D018709:Statistics, Nonparametric
D004921:Erythropoietin; D002097:C-Reactive Protein