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
C2 - 29097485
AN - SCOPUS:85041742578
SN - 0896-8608
VL - 38
SP - 18
EP - 23
JO - Peritoneal Dialysis International
JF - Peritoneal Dialysis International
IS - 1
ER -