The variability and accurate assessment of microinflammation in haemodialysis patients

Tsirpanlis, George; Bagos, Pantelis G.; Ioannou, D.E.; Bleta, Aliki; Marinou, Ioanna; Lagouranis, Antonis; Chatzipanagiotou, Stylianos; Nicolaou, Chryssoula

doi:10.1093/ndt/gfg486

Cited by 61 publications

(51 citation statements)

References 15 publications

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“…First, the number of patients was limited and the cross-sectional nature of the study design prevented us from reaching any mechanistic conclusions. Second, the single point measurement of biomarkers for oxidative stress and inflammation does not permit accurate evaluation (35). Third, we could not identify an association between oxAT and PEW estimated by non-GNRI means and by a quantitative assessment of advanced atherosclerosis.…”

Section: Discussionmentioning

confidence: 82%

Assessment of Myeloperoxidase and Oxidative α1-Antitrypsin in Patients on Hemodialysis

Honda¹,

Ueda²,

Kojima³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: The present study assesses the effects of the oxidative stress marker, myeloperoxidase (MPO), and the possible MPO-related oxidative stress marker, oxidative ␣ 1 -antitrypsin (oxAT), on carotid intima-media thickness (CIMT) and protein-energy wasting (PEW) in patients on hemodialysis (HD).Design, setting, participants, & measurements: Blood samples were obtained from 383 patients before HD to measure WBC count, serum albumin, lipids, high-sensitivity C-reactive protein (CRP), ␣ 1 -antitrypsin (AT), interleukin-6, oxidative LDL-C, MPO, and oxAT. We assessed both CIMT and the geriatric nutritional risk index (GNRI) in this cross-sectional competitive study.Results: Levels of MPO and oxAT correlated. Myeloperoxidase was associated with max-CIMT, and oxAT correlated with max-CIMT and GNRI. Multivariate linear regression models showed that MPO and oxAT were independent predictors of increasing max-CIMT, whereas oxAT, but not MPO, independently correlated with GNRI. In four combined MPO and oxAT groups classified according to median values, a multinomial logistic regression model showed that high MPO together with high oxAT was independently associated with increased max-CIMT. Moreover, the OR for max-CIMT with positive PEW and high MPO was significantly increased in the four groups with combined MPO and PEW.Conclusions: High MPO with high oxAT and high MPO with PEW seem to contribute to plaque formation in patients on HD, whereas elevated MPO or oxAT alone might not predict increasing CIMT. In contrast, a high oxAT value seems to be an independent predictor of PEW in patients on HD.

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Section: Discussionmentioning

confidence: 82%

Assessment of Myeloperoxidase and Oxidative α1-Antitrypsin in Patients on Hemodialysis

Honda¹,

Ueda²,

Kojima³

et al. 2009

Clinical Journal of the American Society of Nephrology

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“…First, inflammation occurs episodically in hemodialysis patients (43), and variation in CRP levels in prevalent HD patients was found as predicted partly by intercurrent events (44,45); therefore, the presence of chronic inflammation at a given time of observation, measured by serum IL-6 levels, may be overestimated. Second, the level of chronic inflammation in HD patients may vary over time, even during a period free of clinically apparent inflammatory events, as shown by Tsirpanlis et al (46). Furthermore, the variability of inflammatory marker levels over time in hemodialysis patients may additionally be influenced by patient-related factors (residual renal function, genetic determinants) or dialysis-specific factors such as membrane bio-incompatibility, dialysate backflow, enditoxemia, and the intermittent nature of hemodialysis (47).…”

Section: Discussionmentioning

confidence: 99%

IL-6 Levels, Nutritional Status, and Mortality in Prevalent Hemodialysis Patients

Beberashvili

Sinuani

Azar

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The influence of serum IL-6 levels on nutritional status in chronic hemodialysis (HD) patients remains to be elucidated. The present report describes a prospective longitudinal study of IL-6 levels and nutritional parameters to determine whether high IL-6 levels are independently associated with nutritional status over time in a cohort of prevalent hemodialysis patients.Design, setting, participants, & measurements 85 clinically stable hemodialysis patients (37.6% women), with a mean age of 66.5 Ϯ 10.6 years, were studied after exclusion of patients with BMI Ͻ 20 kg/m 2 and/or serum albumin Ͻ35 g/L. IL-6, dietary energy and protein intake, and biochemical markers of nutrition and body composition (anthropometry and bioimpedance analysis) were measured at baseline and at 6, 12, 18, and 24 months following enrollment. Observation of this cohort was continued over 2 additional years.Results IL-6 levels increased with time in both unadjusted (linear estimate: 2.57 Ϯ 0.44 pg/ml per 2 yrs; P ϭ 0.001) and adjusted models (linear estimate: 2.35 Ϯ 0.57 pg/ml per 2 yrs; P ϭ 0.049). Significant reductions of daily energy intake, laboratory markers (albumin, transferrin, cholesterol, creatinine), and body composition (fat mass) with higher IL-6 levels were observed over the duration of the longitudinal observation period. However, none of the studied parameters were associated with changes in IL-6 levels over time (IL-6-by-time interactions were NS). Furthermore, cumulative incidences of survival were correlated with the baseline serum IL-6 levels (P ϭ 0.004 by log-rank test). Finally, for each pg/ml increase in IL-6 level, the hazard ratio for death from all causes was 1.06 (95% CI 1.01 to 1.10) after adjustment for demographic and clinical parameters. ConclusionsOur results suggest that higher serum IL-6 levels are associated with all-cause mortality without additional changes in clinical and laboratory markers of nutritional status in clinically stable HD patients.

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“…There are only a few longitudinal studies in which repeated samples have been taken from the same subjects over a period supposedly free of inflammatory clinical events. Variable results have been obtained for IL-6 with reliability coefficients ranging from .87 to .37 (Cava et al, 2000;Rao et al, 1994;Tsirpanlis et al, 2004). The intrinsic biologic variability of inflammatory biomarkers can represent a serious caveat in cross-sectional studies if it is not controlled for by appropriate validation procedures.…”

Section: Standardized Assessmentsmentioning

confidence: 99%

Identification and treatment of symptoms associated with inflammation in medically ill patients

Dantzer

Capuron

Irwin

et al. 2008

Psychoneuroendocrinology

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Medically ill patients present with a high prevalence of non-specific comorbid symptoms including pain, sleep disorders, fatigue and cognitive and mood alterations that is a leading cause of disability. However, despite major advances in the understanding of the immune-to-brain communication pathways that underlie the pathophysiology of these symptoms in inflammatory conditions, little has been done to translate this newly acquired knowledge to the clinics and to identify appropriate therapies. In a multidisciplinary effort to address this problem, clinicians and basic scientists with expertise in areas of inflammation, psychiatry, neurosciences and psychoneuroimmunology were brought together in a specialized meeting organized in Bordeaux, France, on May 28-29, 2007. These experts considered key questions in the field, in particular those related to identification and quantification of the predominant symptoms associated with inflammation, definition of systemic and central markers of inflammation, possible domains of intervention for controlling inflammation associated symptoms, and relevance of animal models of inflammation associated symptoms. This

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The variability and accurate assessment of microinflammation in haemodialysis patients

Cited by 61 publications

References 15 publications

Assessment of Myeloperoxidase and Oxidative α1-Antitrypsin in Patients on Hemodialysis

Assessment of Myeloperoxidase and Oxidative α1-Antitrypsin in Patients on Hemodialysis

IL-6 Levels, Nutritional Status, and Mortality in Prevalent Hemodialysis Patients

Identification and treatment of symptoms associated with inflammation in medically ill patients

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