Increased inflammatory response in association with the initiation of hemodialysis compared with peritoneal dialysis in a prospective study of end-stage kidney disease patients

Kenneth Yong, Gursharan Dogra, Neil Boudville, Wai Lim

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Abstract

Background: Large epidemiological studies have demonstrated an early survival advantage with the initiation of peritoneal dialysis (PD) compared to haemodialysis (HD). Chronic inflammation may contribute to atherosclerosis and cardiovascular (CVD) mortality in end-stage kidney disease (ESKD). We hypothesize that the initiation of HD in ESKD patients is associated with a greater inflammatory response compared with PD. Aims: To examine the effects of initiating HD and PD upon inflammation and CVD risk markers in ESKD patients. Methods: We performed a pilot prospective study on 75 predial-ysis CKD stage-5 subjects comparing the effects of HD and PD upon high sensitivity C-reactive protein (hsCRP), interleukin(IL)-12, IL-18 and pulse wave velocity (PWV). Study visits were conducted 3 – 6 months before (baseline) and after (follow-up) initiation of dialysis. Results: Thirty-nine and 36 patients were initiated on HD and PD respectively. HD patients were older than PD patients (65.1 ± 2.1 vs 57.7 ± 2.7 years; p = 0.03) but had similar baseline systolic blood pressure (SBP), pulse pressure (PP), hsCRP, IL-12, IL-18, and PWV. At follow-up, HD patients had significantly increased hsCRP levels [5.2(3.7, 7.3) vs 1.7(1.0, 2.8)g/L; p < 0.001] compared to PD. Follow-up blood pressure, IL-12, IL-18, and PWV were similar between groups. A significant association remained between hsCRP and HD after adjustment for age, previous CVD, and residual urine output. Conclusion: The initiation of HD was associated with significantly increased hsCRP compared to PD. Further study is required to determine the plausibility of inflammation as a potential underlying contributor to the observed early mortality difference between dialysis modalities.

Original languageEnglish
Pages (from-to)18-23
Number of pages6
JournalPeritoneal Dialysis International
Volume38
Issue number1
DOIs
Publication statusPublished - 1 Jan 2018

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Peritoneal Dialysis
Chronic Kidney Failure
Renal Dialysis
Prospective Studies
C-Reactive Protein
Pulse Wave Analysis
Interleukin-18
Interleukin-12
Blood Pressure
Inflammation
Dialysis
Mortality
Epidemiologic Studies
Atherosclerosis
Urine
Survival

Cite this

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title = "Increased inflammatory response in association with the initiation of hemodialysis compared with peritoneal dialysis in a prospective study of end-stage kidney disease patients",
abstract = "Background: Large epidemiological studies have demonstrated an early survival advantage with the initiation of peritoneal dialysis (PD) compared to haemodialysis (HD). Chronic inflammation may contribute to atherosclerosis and cardiovascular (CVD) mortality in end-stage kidney disease (ESKD). We hypothesize that the initiation of HD in ESKD patients is associated with a greater inflammatory response compared with PD. Aims: To examine the effects of initiating HD and PD upon inflammation and CVD risk markers in ESKD patients. Methods: We performed a pilot prospective study on 75 predial-ysis CKD stage-5 subjects comparing the effects of HD and PD upon high sensitivity C-reactive protein (hsCRP), interleukin(IL)-12, IL-18 and pulse wave velocity (PWV). Study visits were conducted 3 – 6 months before (baseline) and after (follow-up) initiation of dialysis. Results: Thirty-nine and 36 patients were initiated on HD and PD respectively. HD patients were older than PD patients (65.1 ± 2.1 vs 57.7 ± 2.7 years; p = 0.03) but had similar baseline systolic blood pressure (SBP), pulse pressure (PP), hsCRP, IL-12, IL-18, and PWV. At follow-up, HD patients had significantly increased hsCRP levels [5.2(3.7, 7.3) vs 1.7(1.0, 2.8)g/L; p < 0.001] compared to PD. Follow-up blood pressure, IL-12, IL-18, and PWV were similar between groups. A significant association remained between hsCRP and HD after adjustment for age, previous CVD, and residual urine output. Conclusion: The initiation of HD was associated with significantly increased hsCRP compared to PD. Further study is required to determine the plausibility of inflammation as a potential underlying contributor to the observed early mortality difference between dialysis modalities.",
keywords = "Arterial stiffness, End-stage kidney disease, Hemodialysis, Inflammation, Peritoneal dialysis",
author = "Kenneth Yong and Gursharan Dogra and Neil Boudville and Wai Lim",
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month = "1",
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doi = "10.3747/pdi.2017.00060",
language = "English",
volume = "38",
pages = "18--23",
journal = "Peritoneal Dialysis International",
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TY - JOUR

T1 - Increased inflammatory response in association with the initiation of hemodialysis compared with peritoneal dialysis in a prospective study of end-stage kidney disease patients

AU - Yong, Kenneth

AU - Dogra, Gursharan

AU - Boudville, Neil

AU - Lim, Wai

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Large epidemiological studies have demonstrated an early survival advantage with the initiation of peritoneal dialysis (PD) compared to haemodialysis (HD). Chronic inflammation may contribute to atherosclerosis and cardiovascular (CVD) mortality in end-stage kidney disease (ESKD). We hypothesize that the initiation of HD in ESKD patients is associated with a greater inflammatory response compared with PD. Aims: To examine the effects of initiating HD and PD upon inflammation and CVD risk markers in ESKD patients. Methods: We performed a pilot prospective study on 75 predial-ysis CKD stage-5 subjects comparing the effects of HD and PD upon high sensitivity C-reactive protein (hsCRP), interleukin(IL)-12, IL-18 and pulse wave velocity (PWV). Study visits were conducted 3 – 6 months before (baseline) and after (follow-up) initiation of dialysis. Results: Thirty-nine and 36 patients were initiated on HD and PD respectively. HD patients were older than PD patients (65.1 ± 2.1 vs 57.7 ± 2.7 years; p = 0.03) but had similar baseline systolic blood pressure (SBP), pulse pressure (PP), hsCRP, IL-12, IL-18, and PWV. At follow-up, HD patients had significantly increased hsCRP levels [5.2(3.7, 7.3) vs 1.7(1.0, 2.8)g/L; p < 0.001] compared to PD. Follow-up blood pressure, IL-12, IL-18, and PWV were similar between groups. A significant association remained between hsCRP and HD after adjustment for age, previous CVD, and residual urine output. Conclusion: The initiation of HD was associated with significantly increased hsCRP compared to PD. Further study is required to determine the plausibility of inflammation as a potential underlying contributor to the observed early mortality difference between dialysis modalities.

AB - Background: Large epidemiological studies have demonstrated an early survival advantage with the initiation of peritoneal dialysis (PD) compared to haemodialysis (HD). Chronic inflammation may contribute to atherosclerosis and cardiovascular (CVD) mortality in end-stage kidney disease (ESKD). We hypothesize that the initiation of HD in ESKD patients is associated with a greater inflammatory response compared with PD. Aims: To examine the effects of initiating HD and PD upon inflammation and CVD risk markers in ESKD patients. Methods: We performed a pilot prospective study on 75 predial-ysis CKD stage-5 subjects comparing the effects of HD and PD upon high sensitivity C-reactive protein (hsCRP), interleukin(IL)-12, IL-18 and pulse wave velocity (PWV). Study visits were conducted 3 – 6 months before (baseline) and after (follow-up) initiation of dialysis. Results: Thirty-nine and 36 patients were initiated on HD and PD respectively. HD patients were older than PD patients (65.1 ± 2.1 vs 57.7 ± 2.7 years; p = 0.03) but had similar baseline systolic blood pressure (SBP), pulse pressure (PP), hsCRP, IL-12, IL-18, and PWV. At follow-up, HD patients had significantly increased hsCRP levels [5.2(3.7, 7.3) vs 1.7(1.0, 2.8)g/L; p < 0.001] compared to PD. Follow-up blood pressure, IL-12, IL-18, and PWV were similar between groups. A significant association remained between hsCRP and HD after adjustment for age, previous CVD, and residual urine output. Conclusion: The initiation of HD was associated with significantly increased hsCRP compared to PD. Further study is required to determine the plausibility of inflammation as a potential underlying contributor to the observed early mortality difference between dialysis modalities.

KW - Arterial stiffness

KW - End-stage kidney disease

KW - Hemodialysis

KW - Inflammation

KW - Peritoneal dialysis

UR - http://www.scopus.com/inward/record.url?scp=85041742578&partnerID=8YFLogxK

U2 - 10.3747/pdi.2017.00060

DO - 10.3747/pdi.2017.00060

M3 - Article

VL - 38

SP - 18

EP - 23

JO - Peritoneal Dialysis International

JF - Peritoneal Dialysis International

SN - 0896-8608

IS - 1

ER -