Inflammation and overweight in peritoneal dialysis: is there an association?
More than 30% of the patients on peritoneal dialysis show chronic systemic inflammatory activity with high levels of C-reactive protein. The purpose of this cross-sectional study was to investigate the influence of the inflammatory state on clinical and nutritional markers in patients on peritoneal dialysis. Twenty-seven patients were included: mean age was 57.6 +/- 19 years, 48% were male, and median time on peritoneal dialysis was 16.0 (8.3; 35.8) months. Clinical, dialytic, laboratory, anthropometric and electric bioimpedance data were collected with the sample stratified for C-reactive protein. In patients, the levels of Interleukin-6 and tumor necrosis factor-alpha were higher, while adiponectin levels were lower than in healthy individuals (p < or = 0.001), indicating the presence of inflammatory activity in the sample. When compared to patients with C-reactive protein <1 mg/dL, those with > or =1mg/dL showed higher body mass index (29.4 +/- 6.1 vs. 24.4 +/- 4.5 kg/m(2); p = 0.009), percent of standard body weight (124.5 +/- 25.4 vs. 106.8 +/- 17.9 %; p = 0.012), and percent of body fat as assessed by both anthropometry (31.3 +/- 9.9 vs. 23.9 +/- 9.1%; p = 0.056) and bioimpedance (38.9 +/- 6.3 vs. 26.2 +/- 12.6 %; p < 0.001). Patients with C-reactive protein > or =1mg/dL also exhibited higher levels of ferritin (701 +/- 568 vs. 532 +/- 356 ng/mL; p =0.054) and lower total lymphocyte count (median 1838 vs. 1638 mm3; p = 0.001). In conclusion, higher body mass index and body fat markers were associated with C-reactive protein > or = 1mg/dL, and higher C-reactive protein was associated with immunocompetence impairment evidenced by the lower total lymphocyte count. Our findings confirm the relationship between inflammation, body fat, and immunocompetence, which may be superimposed potentializing the inflammatory status.
Department of Clinical Medicine, Botucatu School of Medicine, São Paulo University, UNESP, Botucatu, São Paulo State, Brazil.
Aline
A
de Araujo Antunes
Francieli Delatim
FD
Vannini
Luis Cuadrado
LC
Martin
Andre Luis
AL
Balbi
Daniela
D
Ponce
Hélio Rubens
HR
Nunes
Pasqual
P
Barretti
Jacqueline Costa Teixeira
JC
Caramori
D000328:Adult; D000368:Aged; D001774:Blood Chemical Analysis; D001823:Body Composition; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism*; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000453:epidemiology* / Q000209:etiology; D018836:Inflammation Mediators / Q000097:blood; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D050177:Overweight / Q000453:epidemiology* / Q000209:etiology; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000379:methods*; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D016207:Cytokines; D018836:Inflammation Mediators; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein