title: Accumulation of retained nonfunctional arteriovenous grafts correlates with severity of inflammation in asymptomatic ESRD patients.
abstract: BACKGROUND
  The contribution of multiple retained nonfunctional arteriovenous grafts (AVGs) to the burden of chronic inflammation in chronic hemodialysis patients has not been well studied. Here, we sought to evaluate the association between plasma levels of C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-alpha) and albumin and the number of retained nonfunctional AVGs.
  
  
  METHODS
  This cross-sectional study enrolled 91 prevalent patients undergoing in-center hemodialysis without evidence of infection or inflammation. A baseline blood sample was obtained at study enrollment. A general linear model (GLM) was used to compare levels of biomarkers of systemic inflammation across groups defined by the number of retained, nonfunctional AVGs.
  
  
  RESULTS
  A total of 43 patients had one or more retained thrombosed AVG and had significantly greater plasma log-CRP levels compared with patients without a previous AVG (P= 0.036), regardless of the current AV access type. Using a GLM, we found that for every additional retained thrombosed AVG, plasma log-CRP, log-IL-6 and TNF-alpha concentrations increased significantly by 0.30 mg/L (P= 0.011), 0.18 pg/mL (P= 0.046) and 0.72 pg/mL (P= 0.046), respectively, following adjustment.
  
  
  CONCLUSIONS
  Hence, the severity of inflammation increases with the number of retained nonfunctional AVG's, suggesting that AVG accumulation may contribute to the cardiovascular morbidity and mortality associated with chronic inflammation in asymptomatic end-stage renal disease (ESRD) patients. Further study is indicated to determine whether patients with one or more thrombosed, retained AVG may benefit from periodic screening with CRP monitoring to identify those patients who may benefit from AVG resection.
authors.affiliation: Division of Nephrology, Emory University, Atlanta, GA, USA. hwasse@emory.edu
authors.forename: Haimanot
authors.initials: H
authors.lastname: Wasse
authors.forename: Francesca
authors.initials: F
authors.lastname: Cardarelli
authors.forename: Christine
authors.initials: C
authors.lastname: De Staercke
authors.forename: W Craig
authors.initials: WC
authors.lastname: Hooper
authors.forename: Qi
authors.initials: Q
authors.lastname: Long
mesh_terms: D001166:Arteriovenous Shunt, Surgical; D015415:Biomarkers / Q000032:analysis*; D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D015850:Interleukin-6 / Q000097:blood; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis / Q000009:adverse effects*; D012709:Serum Albumin / Q000032:analysis; D013927:Thrombosis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D012709:Serum Albumin; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein