The level of C‐reactive protein in chronic hemodialysis patients: A comparative study between patients with noninfected catheters and arteriovenous fistula in two large Gulf hemodialysis centers

Abstract

Hemodialysis (HD) patients have greater morbidity and mortality when they have a central venous catheter (CVC) rather than an arteriovenous fistula (AVF) access. Inflammation associated with dialysis catheter use and resultant higher C-reactive protein (CRP) levels could have an independent adverse effect on patient outcomes. In this prospective study, we investigated whether HD catheters induce inflammation independent of infection. We compared the mean levels of the inflammatory marker (CRP) in 67 patients on maintenance HD using noninfected catheters with 86 HD patients using AVFs at Prince Salman Center for Kidney Diseases, Saudi Arabia (KSA), and Jahra Hospital, Kuwait, who met our inclusion criteria. C-reactive protein levels were measured every 2 months over a period of 6 months using immunoturbidimetric assay. One hundred fifty-three patients on maintenance HD for more than 6 months were included in the study, with mean age of 52.19 ± 16.06 years; 66% were males and 34% were females. Serial levels of mean CRP were statistically and significantly higher in group with noninfected catheters (1.33, 1.24, and 1.10 mg/dL) compared to those with AVFs (0.65, 0.59, and 0.68 mg/dL) with P value of 0.000. In our study, we found no relation between CRP level and age, sex, hemoglobin, albumin, calcium, phosphorus, and iPTH level in both groups. Hemodialysis patients with a catheter have a heightened state of inflammation independent of infection, and thus our study supports the avoidance of catheters and a timely conversion to AVFs with catheter removal.

C‐reactive Protein: Repeated Measurements will Improve Dialysis Patient Care

“…Possible therapeutic options are summarized in Table . In patients with persistently high CRP values, a logical approach is to search for hidden potential pathologies like periodontitis , bowel bacterial overgrow , central venous catheter , nonfunctioning graft , undetected malignancy, and so forth. While a heightened attentiveness to the presence of inflammation will lead first of all to treatment of comorbidities (especially infections), other interventions are valuable in the clinical management of “uremic inflammation.” These include improvements in dialysis therapy and fluid status as well as implementation of healthy lifestyle habits including diet modifications and an increase in physical activity .…”

“…While a heightened attentiveness to the presence of inflammation will lead first of all to treatment of comorbidities (especially infections), other interventions are valuable in the clinical management of “uremic inflammation.” These include improvements in dialysis therapy and fluid status as well as implementation of healthy lifestyle habits including diet modifications and an increase in physical activity . As the use of central venous dialysis catheters is a common source of inflammation in HD patients their use should be limited and as short as possible.…”

Briefly Noted

“…In a prospective study of C reactive protein in HD patients (measured three times in six months), levels in the 67 patients using uninfected tunneled internal jugular catheters were about twice those found in 86 patients using AV fistulas (1.22 vs. 0.64 mg/dl) . Levels did not correlate with patient's age, albumin, PTH or hemoglobin levels.…”

Imuninės Sistemos Senėjimas Ir Lėtinė Inkstų Liga

“…Viena tokių priemonių -tinkamas kraujagyslinės prieigos pasirinkimas. Yra žinoma, jog sepsio ir mirtingumo rizika yra didesnė pacientams, dializuojamiems per kateterį (net ir tunelinį), palyginti su tais pacientais, kurių kraujagyslinė prieiga yra arterioveninė fistulė [3,4], todėl labai svarbu lėtine inkstų liga sergantį pacientą laiku pradėti ruošti pakaitinei inkstų terapijai, išvengiant skubios dializės per laikiną centrinės venos kateterį, taip pat saugoti ir tinkamai punktuoti suformuotą arterioveninę fistulę, kad ši tarnautų kuo ilgiau.…”