Vascular access type and changes in inflammatory markers in incident dialysis patients: A pilot study

Mala Sachdeva, Oleksander Kovalchuk, Markus Bitzer, Michele Helene Mokrzycki

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Purpose: To determine the association between the initial hemodialysis (HD) vascular access type and short-term changes in inflammation markers. Methods: This is a prospective, observational study in incident chronic kidney disease (CKD) (stages 4 and 5) patients receiving their first HD vascular access. Serum samples were obtained pre-access placement, and 1 week, and 1 month post-access insertion. Samples were tested for high sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6) using ELISA. Patients with known inflammatory states (infection, malignancy, connective tissue disorders, organ transplantation and those on immune modulating agents) were excluded. The hsCRP and IL-6 values were transformed into logarithmic scale. Chi-square analysis, independent and paired t-tests were performed where appropriate, and a two-way ANOVA with time as a repeated measure was also performed. Significance was determined at p=0.05. Results: One-month follow-up data was obtained in 48 patients (arteriovenous fistula (AVF), n=10; tunneled catheter (TC), n=28; arteriovenous graft (AVG), n=10). A significant increase in both hsCRP (p<0.05) and IL-6 (p=0.02) occurring 1 week after TC insertion was observed. Elevation of the IL-6 levels appeared to be sustained 1 month after TC insertion, although this finding was not statistically significant (p=0.68), whereas the hsCRP levels returned to baseline within 1 month. After AVG insertion only the hsCRP levels rose significantly (p=0.01) after 1 week and returned to baseline within 1 month. In the AVF group, inflammatory markers did not change for any time period. Conclusions: In CKD patients, TC and AVG insertion result in a transient state of inflammation 1 week post-operatively, which is not observed after AVF surgery. Whether this is a persistent phenomenon after TC insertion requires a larger, longitudinal study.

Original languageEnglish (US)
Pages (from-to)174-179
Number of pages6
JournalJournal of Vascular Access
Volume10
Issue number3
StatePublished - Nov 18 2009

Keywords

  • C-reactive protein
  • Chronic kidney disease
  • Hemodialysis
  • Inflammation
  • Interleukin-6
  • Vascular access

ASJC Scopus subject areas

  • Surgery
  • Nephrology

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