title: A single center, open-label, randomized, parallel group study assessing the relationship between asymptomatic bacteriuria and inflammation in maintenance hemodialysis patients.
abstract: The significance of asymptomatic bacteriuria in maintenance hemodialysis (MHD) patients remains controversial. We hypothesized that the presence of asymptomatic bacteriuria as a sole clinical manifestation of urinary tract infection (UTI) in asymptomatic MHD patient may contribute to the chronic inflammatory response. Our aim was to explore the relationship between asymptomatic bacteriuria and elevated levels of inflammatory markers in MHD patients.
  
  
  
  A randomized open-label single center study of 114 MHD patients was conducted. Forty-six patients presented negative urine culture and 41 subjects were excluded due to different reasons. The remaining 27 patients (mean age of 71.5 ± 12.2 years, 63% men), fulfilling the criteria for having asymptomatic bacteriuria, were randomly assigned to either the treatment group (13 patients) or the observational group (14 subjects). The treatment group received 7 days of antibiotic treatment given according to bacteriogram sensitivity. After 3 months of follow-up all measurements of the study were repeated. The primary end point was change in inflammatory biomarkers from baseline by the end of the study.
  
  
  
  There were no statistically significant differences in white blood cell changes (P = 0.27), ferritin (P = 0.09), C-reactive protein (P = 0.90), and interleukin-6 (P = 0.14) levels between the groups from baseline to the end of study or at the end of the study. Analyzing cross-sectional data, asymptomatic bacteriuria was found to not be a predictor of higher levels of inflammatory parameters at baseline.
  
  
  
  Asymptomatic bacteriuria is not a modifiable risk factor for chronic inflammation in the MHD population.
authors.affiliation: Nephrology Division, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Ilia
authors.initials: I
authors.lastname: Beberashvili
authors.affiliation: Internal Department F, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Evgeni
authors.initials: E
authors.lastname: Golovko
authors.affiliation: Nephrology Division, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Liat
authors.initials: L
authors.lastname: Golinsky
authors.affiliation: Nephrology Division, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Nedal
authors.initials: N
authors.lastname: Garra
authors.affiliation: Department of Pathology, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Inna
authors.initials: I
authors.lastname: Sinuani
authors.affiliation: Nephrology Division, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Leonid
authors.initials: L
authors.lastname: Feldman
authors.affiliation: Internal Department F, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Oleg
authors.initials: O
authors.lastname: Gorelik
authors.affiliation: Nephrology Division, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Shai
authors.initials: S
authors.lastname: Efrati
authors.affiliation: Urology Department, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Kobi
authors.initials: K
authors.lastname: Stav
mesh_terms: D000368:Aged; D001437:Bacteriuria / Q000209:etiology* / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007249:Inflammation / Q000209:etiology* / Q000473:pathology; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods
keywords: Bacteriuria; CRP; IL-6; hemodialysis; inflammation