Abstract
Background People receiving hemodialysis (HD) treatment have higher cardiovascular morbidity and mortality, ascribed to an increased prevalence of traditional cardiovascular risk factors. However, the role of nontraditional risk factors, such as inflammation, has become increasingly recognized. The origin of this inflammation remains elusive and one putative cause is elevated levels of circulating bacterial endotoxin. Methods In this study, serum concentrations of endotoxin and inflammatory biomarkers, including high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), interleukin-1β (IL1β), ferritin and tumor necrosis factor (TNF), were measured in 30 adults receiving HD and 10 healthy individuals without kidney disease. In people receiving HD, samples were collected immediately before dialysis (preHD), after dialysis (postHD), and 48 hours after (postHD48hrs). Results Endotoxin was detectable in only 1 of 90 samples analyzed. There were no significant differences in serum hsCRP, IL1β, and IL6 levels, before and after dialysis. Serum TNF levels decreased significantly from 30.9 (8.0, 39.5) pg/mL preHD to 13.9 (8.5, 17.3) pg/mL post-HD (p=0.002) and then increased back to 27.37 (14.5, 35) pg/mL 2 days later (p < 0.001). Ferritin increased from 1153 ng/mL (782, 1458) preHD to 1313 ng/mL (657, 1638) post HD (p < 0.001) and then decreased back to 1186 ng/mL (754, 1597) (p=0.66) postHD48hrs. Compared to controls, people receiving HD had significantly elevated levels of hsCRP [6.16 mg/L (2.1, 16.8) vs. 1.1 mg/L (0.81, 3.63) p=0.015], IL1β [1.5 pg/mL (0.05, 2.51) vs. 0.5 pg/mL (1.81, 2.95) p ≤ 0.001], and ferritin [1153 (782, 1458) vs. 132.9 (111, 257) ng/mL p ≤ 0.001], but comparable levels of in IL6 [6.15 pg/mL (4.82, 9.12) vs. 7.49 pg/mL (4.56, 10.39), p=0.77] and TNF [27.35 pg/mL ± 17.48 vs. 17.87 pg/mL ± 12.28, p < 0.12]. In conclusion, people on HD have elevated levels of inflammatory biomarkers, which are not associated with endotoxemia (which is rare) or the dialysis procedure.
Highlights
People with kidney failure experience high rates of cardiovascular morbidity and mortality despite receiving hemodialysis (HD) therapy [1]
Endotoxin was detectable in only 1 of 90 samples analyzed. ere were no significant differences in serum high-sensitivity C-reactive protein (hsCRP), IL1β, and interleukin 6 (IL6) levels, before and after dialysis
Serum levels of hsCRP, IL1β, and ferritin were all significantly lower in controls compared to patients receiving HD, whilst serum IL6 and tumor necrosis factor (TNF) concentrations were comparable between control and dialysis samples (Table 3). In this cross-sectional observational study of 30 patients receiving hemodialysis, circulating endotoxin was only detected in 1% of serum samples tested, whilst serum concentrations of inflammatory biomarkers were significantly elevated compared with those of healthy controls. ere was no compelling evidence of an association between serum endotoxin and inflammatory biomarker measurements or between these measurements and the dialysis procedure itself
Summary
People with kidney failure experience high rates of cardiovascular morbidity and mortality despite receiving hemodialysis (HD) therapy [1]. Various factors contribute to these adverse outcomes, including hypertension, diabetes, and obesity [2, 3] These traditional cardiovascular risk factors only partially explain the increased incidence of cardiovascular disease, thereby prompting evaluation of the role of nontraditional risk factors, such as inflammation [3, 4]. Erefore, it is plausible that elevated levels of inflammation in the dialysis population may be related to the actual process of dialysis. People receiving hemodialysis (HD) treatment have higher cardiovascular morbidity and mortality, ascribed to an increased prevalence of traditional cardiovascular risk factors. Serum concentrations of endotoxin and inflammatory biomarkers, including high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), interleukin-1β (IL1β), ferritin and tumor necrosis factor (TNF), were measured in 30 adults receiving HD and 10 healthy individuals without kidney disease. People on HD have elevated levels of inflammatory biomarkers, which are not associated with endotoxemia (which is rare) or the dialysis procedure
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