title: Microinflammation is involved in the dysfunction of arteriovenous fistula in patients with maintenance hemodialysis.
abstract: BACKGROUND
  Vascular access (VA) dysfunction is a major clinical complication in the hemodialysis population and has a direct effect on dialysis outcome. This study was conducted to explore the role of microinflammation in the VA dysfunction in maintenance hemodialysis patients.
  
  
  METHODS
  Forty-seven patients (male 35 and female 12) receiving maintenance hemodialysis were included for this study. They were divided into three groups: group 1 (n = 15), patients with initial hemodialysis and new arteriovenous fistula (AVF); group 2 (n = 18), patients treated with hemodialysis for long term with well-functional VA; group 3 (n = 14), maintenance hemodialysis patients with VA dysfunction. Biochemical parameters and serum tumor necrosis factor-alpha (TNF-alpha), interleukin 6 (IL-6) and monocyte chemoattractant protein-1 (MCP-1) were determined. High-sensitivity C-reactive protein (hs-CRP) was determined by latex-enhanced immuno-nephelometric method. Tissues of radial artery were taken from group 1 and group 3 for the histological study. Expression of CD68 and MCP-1 in the radial artery was determined by immunohistochemistry.
  
  
  RESULTS
  Serum hs-CRP in group 3 was significantly higher than those in group 1 and group 2 ((7.40 +/- 2.42) mg/L vs (4.21 +/- 1.62) mg/L and (5.04 +/- 3.65) mg/L, P < 0.01 and P < 0.05, respectively). Serum TNF-alpha in group 3 was significantly higher than those in group 1 and group 2 ((64.03 +/- 9.29) pg/ml vs (54.69 +/- 12.39) pg/ml and (54.05 +/- 7.68) pg/ml, P < 0.05 and P < 0.01, respectively). Serum IL-6 in group 3 was also significantly higher than those in group 1 and group 2 ((70.09 +/- 14.53) pg/ml vs (56.43 +/- 10.11) pg/ml and (60.77 +/- 9.70) pg/ml, P < 0.01 and P < 0.05, respectively). Patients in group 3 had a thicker internal layer of vessels than in group 1 ((0.356 +/- 0.056) mm vs (0.111 +/- 0.021) mm, P < 0.01). Expression of CD68 and MCP-1 in the fistula vessel walls in group 3 were much higher than those in group 1 (P < 0.01). Moreover, serum hs-CRP level was positively correlated with the neointimal hyperplasia, the expression of CD68 and MCP-1 in fistula vessel (P < 0.01, respectively).
  
  
  CONCLUSIONS
  Microinflammation might be involved in the dysfunction of AVF in patients with maintenance hemodialysis.
authors.affiliation: Institute of Nephrology, Zhong Da Hospital, Southeast University, Nanjing, Jiangsu 210009, China. liubc64@yahoo.com.cn
authors.forename: Bi-cheng
authors.initials: BC
authors.lastname: Liu
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.forename: Min
authors.initials: M
authors.lastname: Gao
authors.forename: Yan-li
authors.initials: YL
authors.lastname: Wang
authors.forename: Ji-rong
authors.initials: JR
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007249:Inflammation / Q000209:etiology*; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*
chemical_list: D015850:Interleukin-6; D002097:C-Reactive Protein