C-reactive Protein In Hemodialysis Patients Research Articles

Effects of the Malnutrition-Eat Additional Meal (MEAM) Diet on the Serum Levels of Albumin and C-Reactive Protein in Hemodialysis Patients.

The main objective of this project was to evaluate the efficiency of two kinds of nutritional intervention implemented in hemodialysis patients for 24 weeks (traditional nutritional intervention without a meal served before dialysis for group HG1, and nutritional intervention involving a meal served before dialysis for group HG2), and their impact on nutritional status and serum concentrations of C-reactive protein (CRP). Nutritional status and serum biochemical parameters were analyzed in the control group (CG, n = 70) and in two homogeneous groups of patients, HG1 (n = 35) and HG2 (n = 35). There was an interesting trend in both groups of patients connected with increased intake, mainly of energy and protein. In HG1, the greatest increase in energy intake was observed on Sundays, and in HG2 on the days with dialysis. In HG2, after 24 weeks of the nutritional intervention, an increase in serum albumin (p = 0.0157) and a decrease in CRP concentration (p = 0.0306) were observed, whereas in HG1 there was a decrease in serum albumin concentration (p = 0.0043) with no significant change in CRP concentration. The nutritional intervention applied, called the Malnutrition-Eat Additional Meal (MEAM) diet with an easily digestible meal served before dialysis, was aimed at improving the patients' nutritional status and the obtained results indicate the need not only for substantial reeducation of hemodialysis patients in the area of their diet, but also for undertaking further research and discussions on the possibility of ensuring adequate meals for hemodialysis patients before the dialysis procedure.

Correlation between Fibroblast Growth Factor 23 and C-reactive Protein in Hemodialysis Patients

Correlation between Fibroblast Growth Factor 23 and C-reactive Protein in Hemodialysis Patients

Effect of melatonin on C-reactive protein and lipid profile of hemodialysis patients

Introduction: Cardiovascular disease is one of the major causes of death in hemodialysis patients. Lipid metabolism abnormalities and increased inflammatory factors are related factors. In recent studies, melatonin inhibits dyslipidemia and reduces inflammatory factors by inhibiting LDL-C oxidation. The purpose of this study was to evaluate the effect of melatonin supplement on hyperlipidemia and C-reactive protein (CRP) level in hemodialysis patients. Objectives: We aimed to determine the effect of melatonin on CRP and lipid profile of hemodialysis patients. Patients and Methods: Among 200 hemodialysis patients, only 28 patients fulfilled the inclusion criteria to enroll in the study. Patients were treated with melatonin supplements 3 mg/d at bedtime for 12 weeks. Serum lipid profile and CRP levels were measured after 12 weeks. Five patients were excluded, 2 patients underwent kidney transplantation, and three patients did not cooperate. The Wilcoxon signed-rank test was used to compare the two groups according to the number of participants (less than 30) and study type (pre-test and post-test). P <0.05 was considered as the level of significance. Results: A total of 23 patients completed the treatment protocol. Participants was composed of 13 male and 10 female. The participants’ mean age was 30.6± 11.6 years. After treatment mean total cholesterol levels decreased from 139.95±35.49 mg/dL to 131.13 ± 34.96 mg/dL (P=0.194) which was not statistically significant. However, the decrease in serum triglyceride level was statistically significant (P=0.004). Plasma HDL-C increased significantly after treatment (P=0.032). Serum CRP levels did not change. Conclusion: Melatonin supplement improves serum triglyceride and HDL-C levels in hemodialysis patients but has no effect on total cholesterol and CRP in hemodialysis patients. Trial Registration: This randomized controlled trial was registered by the Iranian Registry of Clinical Trials (identifier: IRCT20200308046724N1; https://en.irct.ir/trial/46407, ethical code; IR.SBMU.RETECH.REC.1397.687).

The effect of fish oil on inflammation markers in adult patients undergoing hemodialysis: A meta-analysis.

This meta-analysis was to assess the effect of fish oil supplementation on inflammation markers in adult patients receiving hemodialysis. CENTRAL, EMBASE, MEDLINE databases were searched from inception to 10 April 2020. Two authors independently searched, selected, and screened the literature. The pooled results are represented by WMD or SMD with 95% confidence intervals. Subgroup analysis and meta-regression were used to explore sources of heterogeneity, and sensitivity analysis was used to assess the robustness of the pooled results. Funnel plots were used to assess publication bias. Eleven RCT (randomized control trials) studies were included. The pooled results showed that fish oil supplementation caused a significant reduction of the CRP(C-reactive protein) level (random model: WMD, -3.36, 95%CI: -5.46 to -1.26, P= .002), especially in patients with baseline CRP ≥5mg/L (random model: WMD, -4.43, 95%CI: -6.10 to -2.76, P= .00001, I2 = 41%). Meta-regression analyses showed that CRP baseline level (CRP <5mg/L) was the main source of heterogeneity (P= .036). Sensitive analyses revealed that the result was hardly changed. Fish oil supplementation might not reduce the level of IL-6 (random model: WMD, -2.26, 95%CI: -19.61 to 15.09, P= .80) in four studies or the level of TNF-α (random model: SMD, -2.51, 95%CI: -6.08 to 1.06, P= .17) in three studies. Fish oil supplementation could reduce the level of CRP in hemodialysis patients, especially in patients with CRP ≥5mg/L, but had no effects on IL-6 and TNF-α.

P1272ECFECT OF MELATONIN ON DYSLIPIDEMIA IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Cardiovascular disease is one of the major causes of death in hemodialysis patients. Lipid metabolism abnormalities and increased inflammatory factors are related factors. In recent studies melatonin inhibits dyslipidemia and reduces inflammatory factors by inhibiting LDL-c oxidation. The purpose of this study was to evaluate the effect of melatonin supplement on hyperlipidemia and c reactive protein (CRP ) level in hemodialysis patients. Method In this clinical trial ,the inclusion criteria were as follows:age older than 18 years, undergoing dialysis for at least 3 months,triglyceride &amp;gt;150mg/dL,HDL-c&amp;lt;40 mg/dL in males, HDL-c&amp;lt;50 mg/dL in females and serum CRP&amp;gt;5 mg/l Exclusion criteria were: Patients with a history of stroke, myocardial infarction, peripheral vascular disease, malignancy, heart failure, liver cirrhosis, active liver disease, history of infection, hospitalization one month ago, hepatitis B and C.HIV, and taking corticosteroid, statin, Non-steroidal anti-inflammatory drugs. Among 200 hemodialysis patients,only 28 patients fulfilled the inclusion criteria.. Patients were treated with Melatonin supplements 3 mg per day at bedtime during 12 weeks. Serum lipid profile and CRP level were measured after 12 weeks. Five patients were excluded, 2 patients underwent kidney transplantation, and three patients did not cooperate. Data were analyzed by SPSS 20 software. Normal distributed quantitative data were expressed as the mean ± SD and qualitative data was expressed as frequency and percentage. Wilcoxon matched pairs test was used to compare the two groups according to the type of study that had no normal distribution and the number of participants (less than 30) and study type (pre-test and post-test). P &amp;lt;0.05 was considered as the level of significance. Results A total of 23 patients completed the treatment protocol.Baseline demographic characteristics of patient are shown in Table 1.Parcipitant was composed of 13 male and 10female .The participants’ mean age was 30.6± 11.6.Etiology of ESRD was diabetes in 13(56/5%)and hypertension in5(21.7%)patients and other causes was 5(21/7%). After treatment mean total cholesterol levels decreased from 139.95 ± 35.49 mg/dL to 131.13 ± 34.96 mg/dL (p value =0.194 ) which was not statistically significant. But the decrease in serum triglyceride level was statistically significant ,from 242.08 ± 101.05 mg/dL decreased to 178.00 ± 48.02 mg/dL (pvalue = 0.004).HDL-c increased significantly after treatment from 36.20 ±7.08 mg/dL to 40.16 ±4.35mg/dL (pvalue =0.032). Serum CRP levels did not decreased.The limitations of our study were the small sample size and short duration of the investigation. Conclusion Melatonin supplement improves triglyceride and HDL-c in hemodialysis patients but has no effect on total cholesterol-c and CRP in hemodialysis patients.

Correction to: Interleukin 6 is a better predictor of 5-year cardiovascular mortality than high-sensitivity C-reactive protein in hemodialysis patients using reused low-flux dialyzers.

The article "Interleukin 6 isabetter predictor of5-year cardiovascular mortality thanhigh-sensitivity C-reactive protein inhemodialysis patients using reused low-fux dialyzers".

Relationship between Hepcidin, Ferritin and C-Reactive Protein in Hemodialysis Patients

Objective: Uremia is a state of heightened inflammatory activation. This might have an impact on several parameters including those used in the management of anemia as ferritin, serum iron, transferrin saturation, C-reactive protein (CRP) and hepcidin levels. In spite of this complexity the existing data indicate that hepcidin has an advantage over ferritin in guiding treatment of anemia in patients with chronic kidney disease (CKD) as it directly reflects iron availability and the status of iron homeostasis. Aim of the study: was to determine serum hepcidin levels in maintenance haemodialysis (HD) patients and to investigate its relation to ferritin and markers of inflammation as C-reactive protein. Subjects and methods: This study was conducted on 40 maintenance haemodialysis patients and 20 age-matched apparently healthy controls from October 2015 till February 2016 at the Haemodialysis Departement, National Institute of Urology and Nephrology (NIUN). Creatinine, albumin, hemoglobin, leucocytic count, CRP, hepcidin and ferritin were measured. Results: Serum ferritin and hepcidin levels were significantly higher in HD patients compared with controls (825.67 ± 956.52 ng/ml and 9.2 ± 4.2 ng/ml vs 85.1± 63.35 ng/ml and 0.75 ± 0.39 ng/ml respectively) (p< 0.001).There was significant difference in CRP in HD patients compared with controls (4.28 ± 3.7mg/L vs 1.35±1.04mg/L respectively)(p<0.05).There were insignificant positive weak correlations between serum levels of hepcidin and ferritin (r = 0.05, P = 0.74). Conclusion: Serum hepcidin levels are increased in HD patients and, hence, could be used in the evaluation of anemia in such patients. Serum hepcidin provides useful information about the level and availability of iron during inflammation as compared with traditional markers of iron status. Availability of the ELISA assay for serum hepcidin will facilitate the routine measurement of hepcidin in clinical practice.

Impact of sertraline on serum concentration of CRP in hemodialysis patients with depression.

Introduction: Depression is the most prevalent psychological problem among hemodialysis (HD) patients. Inflammatory factors have been reported to play an important role in the pathogenesis of depression. The association between depression and inflammatory factors was established in chronic kidney disease (CKD) patients. Sertraline, a selective serotonin reuptake inhibitor (SSRI) antidepressant, decreases serum levels of inflammatory factors in patients with depression. Objectives: This study was designed to assess the effect of sertraline on serum concentration of C-reactive protein (CRP), hemoglobin and albumin of depressed hemodialysis (HD) patients. Patients and Methods: During a clinical trail, 35 depressed HD patients, and CRP >5 were allocated to receive sertraline for 12 weeks. Patients’ depression was assessed using Beck depression inventory second edition (BDI-II) biochemical parameters (hemoglobin, serum albumin, etc) and CRP levels were measured at baseline and at weeks 4, 8 and 12 of the study. BDI-II score was evaluated before and after 12 weeks treatment with sertraline. Results: Sertraline significantly improved depression symptoms in HD patients. At the end of the study, BDI-II scores significantly changed from baseline (P=0.001) and serum levels of CRP significantly decreased at week 12 of initiation of the study (P=0.001). However, the concentration of hemoglobin and serum albumin concentration and weight was not changed significantly (P=0.995 and P=0.328, respectively). Conclusion: Sertraline significantly decreases CRP levels and can be a promising strategy to reduce the systemic inflammation and to treat depression in HD patients.

Relationship of Neutrophil-to-Lymphocyte Ratio and Serum Albumin Levels with C-Reactive Protein in Hemodialysis Patients: Results from 2 International Cohort Studies

Background/Aim: The neutrophil-to-lymphocyte ratio (NLR), defined as the neutrophil count divided by lymphocyte count, is an inexpensive and readily available parameter, which may serve as a surrogate for inflammation markers, such as C-reactive protein (CRP). The aim of this study was to determine the utility of NLR in the prediction of elevated CRP levels in hemodialysis (HD) patients. Methods: We analyzed 43,272 HD patients from 2 distinct cohorts within the Monitoring Dialysis Outcomes research collaboration in whom contemporaneous measurements of neutrophil and lymphocyte counts, serum albumin and CRP levels were available. Logistic regression was used to determine the relationship of trichotomized NLR (<2.5, 2.5-5 and >5.0) and albumin levels (<3.1, 3.1-4.0 and >4.0 g/dl) with elevated CRP levels (>10.0, >20.0 and >30.0 mg/l). Congruence of the prediction models was examined by comparing the regression parameters and by cross-validating each regression equation within the other cohort. Results: We found that NLR >5.0 vs. <2.5 (cohort 1: OR 2.3; p < 0.0001 and cohort 2: OR 2.0; p < 0.0001) was associated with CRP levels >10.0 mg/l. Stepwise increase in odds ratio for CRP >10.0 mg/l was observed with the combination of high NLR and low albumin levels (NLR >5.0 and albumin <3.1) (cohort 1: OR 7.6; p < 0.0001 and cohort 2: OR 11.9; p < 0.0001). Cross-validation of the 2 regression models revealed a predictive accuracy of 0.68 and 0.69 in the respective cohorts. Conclusion: This study suggests that NLR could serve as a potential surrogate marker for CRP. Our results may add to diagnostic abilities in settings where CRP is not measured routinely in HD patients. NLR is easy to integrate into daily practice and may be used as a marker of systemic inflammation.

C-reactive protein and carotid and femoral intima media thickness: predicting inflammation

C-reactive protein (CRP) is a recognized marker of systemic inflammation. Its association with carotid and femoral intima media thickness (surrogate measures of atherosclerosis) may explain excess cardiovascular disease risk in hemodialysis patients. To estimate the association between CRP and both carotid and femoral IMT in hemodialysis (HD) patients; to predict CRP in these patients. The present cross-sectional study is nested in the Sevelamer hydrochloride and ultrasound-measured femoral and carotid intima media thickness progression in end-stage renal disease (SUMMER) clinical trial. Carotid (common, internal, and bifurcation) and femoral arteries were visualized in B-mode ultrasonography. CRP was measured in serum. The study cohort included 144 HD patients (39.5% female, mean age 67.8 ± 11.5 years). All measures of both carotid and femoral IMT were significantly positively associated with CRP. Subjects with a history of smoking or coronary revascularization had significantly higher CRP levels, while subjects treated with sevelamer hydrochloride had significantly lower CRP. CRP was significantly positively associated with serum phosphorus, calcium, alkaline phosphatase, and PTH, and significantly inversely associated with HDL and albumin. CRP is significantly positively associated with both femoral and carotid IMT. Treatment with sevelamer hydrochloride is associated with lower CRP in HD patients.

Association of left ventricular hypertrophy with high-sensitive C-reactive protein in hemodialysis patients

Micro inflammation and cardiovascular disease such as left ventricular hypertrophy (LVH) are common in hemodialysis (HD) patients. Hence, we have evaluated the relationship between high-sensitive C-reactive protein (hs-CRP), as an inflammation marker, and left ventricular mass index (LVMi) and left ventricular mass (LVM) in HD patients. An analytical cross-sectional study was performed in 104 HD patients. Serum hs-CRP, LVMi, LVM, and blood pressure were evaluated; demographic data and duration of HD were also recorded. Finally, results were analyzed by using Student's t test, Pearson's correlation coefficient, one-way ANOVA and multiple regression to determine the relationship between LVMi and other variables. A total of 66 male patients (63.46 %) and 38 female patients, with a mean age of 51.75 ± 15.98 years-old, participated in this study. Hypertension was the most common underlying disease (65.4 %). The mean LVMi was 366.98 ± 120.89 g/m(2) and the mean hs-CRP was 8.55 mg/l. Eighty-nine percent of patients had LVH. The hs-CRP level was significantly associated with age and with LVM (P = 0.0001, P = 0.039, respectively). On multivariate analysis, hs-CRP and systolic blood pressure were found to be independent predictors of LVM and LVMi. This study shows that hs-CRP and systolic BP are independent predictors of LVH in HD patients.

Pentoxifylline decreases serum levels of tumor necrosis factor alpha, interleukin 6 and C-reactive protein in hemodialysis patients: results of a randomized double-blind, controlled clinical trial

The aim of this study was to compare the effect of pentoxifylline versus placebo on serum concentrations of tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6) and C-reactive protein (CRP) of hemodialysis (HD) patients. This is a randomized double-blind, controlled clinical trial. HD patients without infection or drugs with anti-inflammatory effect were randomly allocated to a study (n = 18, pentoxifylline 400 mg/day) or control (n = 18, placebo) group; all patients had arteriovenous fistula. Besides clinical and laboratory monthly assessments, serum TNF-α and IL-6 (ELISA) and CRP (nephelometry) were measured at 0, 2 and 4 months. All the inflammation markers significantly (P < 0.05) decreased in the pentoxifylline group: TNF-α [baseline 0.4 (0-2) versus final 0 (0-0) pg/mL], IL-6 [baseline 9.4 (5-14) versus final 2.9 (2-5) pg/mL] and CRP [baseline 7.1 (3-20) versus final 2.6 (1-8) mg/L], whereas no significant changes were observed in the placebo group: TNF-α [baseline 0 (0-0) versus final 1.2 (0-4) pg/mL], IL-6 [baseline 8.0 (5-11) versus final 8.7 (4-11) pg/mL] and CRP [baseline 4.5 (2-9) versus final 3.8 (3-23) mg/L]. Pentoxifylline significantly decreased serum concentrations of TNF-α, IL-6 and CRP compared to placebo. Pentoxifylline could be a promising and useful strategy to reduce the systemic inflammation frequently observed in patients on HD.

Relationship between Abdominal Fat Accumulation and Insulin Resistance in Hemodialysis Patients

It is well known that obesity and insulin resistance are closely related to the development of type 2 diabetes. However, the exact pathogenic mechanism underlying the insulin resistance in renal disease has not been clarified. The purpose of the present study was to clarify the contribution of abdominal (visceral and subcutaneous) fat accumulation to insulin resistance and various clinical parameters, including C-reactive protein (CRP), in hemodialysis (HD) patients. Visceral and subcutaneous fat areas (VFA and SFA) were evaluated at the umbilical level by CT. Insulin resistance was estimated by the homeostasis model assessment-insulin resistance index (HOMA-IR) in 80 HD patients. Insulin resistance and CRP seemed to be closely correlated with fat-related parameters such as body mass index (BMI), VFA and SFA. HOMA-IR was positively correlated with BMI, VFA, SFA, triglycerides (TG), remnant-like particle (RLP)-cholesterol and CRP in simple regression analysis. In multiple stepwise regression analysis, SFA and RLP-cholesterol were predominant determinants of HOMA-IR in HD patients. Furthermore, CRP was positively correlated with BMI, VFA, SFA, TG, high-density lipoprotein (HDL)-cholesterol, atherosclerosis index (AI), immunoreactive insulin (IRI) and HOMA-IR in simple regression analysis. In multiple stepwise regression analysis, VFA and HDL-cholesterol were predominant determinants of CRP in HD patients. In conclusion, insulin resistance and CRP were related to fat-related parameters such as BMI, VFA and SFA in HD patients. Furthermore, the contribution of SFA to insulin resistance was much higher than that of VFA, while the opposite relation was recognized for CRP.

Fetuin-A, Valve Calcification, and Diabetes

In the current issue of Circulation , Ix et al demonstrate an inverse correlation between mitral and aortic valve calcification and serum fetuin-A levels in a cross-sectional study of 970 patients with coronary artery disease and without renal disease.1 Increased serum fetuin was significantly associated with diabetes mellitus, hypertriglyceridemia, serum albumin, and body mass index, with a weaker association with serum C-reactive protein, low-density lipoprotein cholesterol, and serum calcium. The link between aortic stenosis and fetuin held only in those without diabetes.1 The data highlight the complex interactions of fetuin with inflammation, insulin resistance, and tissue calcification. Furthermore, the results, though intriguing, underscore our lack of understanding of the cellular mechanisms of calcification in diverse pathological substrates, such as the degenerating aortic leaflet and mitral annulus. Article p 2533 Fetuin is a member of the cystatin superfamily of cysteine protease inhibitors, originally discovered as the major component of fetal bovine serum. It is a carrier for growth factors, binds to and inactivates transforming growth factor (TGF)–β and bone morphogenic protein, and is a major component of mineralized bone.2 Fetuin-A is also an acute-phase glycoprotein, produced in adults primarily in the liver, and is a powerful circulating inhibitor of hydroxyapatite formation. Mice that lack fetuin-A exhibit extensive soft-tissue calcification, which is accelerated on a mineral-rich diet, which suggests that fetuin-A acts to inhibit calcification systemically.3 In addition to its effects on mineralization, fetuin-A inhibits insulin receptor autophosphorylation and tyrosine kinase activity in vitro and in vivo. Fetuin-null knockout mice demonstrate improved insulin sensitivity and resistance to diet-induced obesity, and it has been postulated that the absence of fetuin in mice may contribute to the improvement of insulin sensitivity associated with aging.4 Clinically, serum fetuin-A is decreased in patients with moderate to severe chronic kidney disease, especially …

Effects of atorvastatin on triglyceride-rich lipoproteins, low-density lipoprotein subclass, and C-reactive protein in hemodialysis patients

Dyslipidemia is an important risk factor for cardiovascular disease in patients with chronic renal failure (CRF). We evaluated the safety and efficacy of atorvastatin in patients with dyslipidemia associated with CRF who were undergoing hemodialysis (HD). Thirty-five patients who were receiving HD were given atorvastatin (10 mg/d) for 3 months. Chylomicron (CM), light and dense very-low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), and light and dense low-density lipoprotein (LDL) were separated by ultracentrifugation. Apolipoprotein (apo) B was measured by electroimmunoassay. Mean LDL particle diameter was measured by gradient gel electrophoresis. Atorvastatin therapy reduced LDL-cholesterol (C) by 36% and remnant-like particle (RLP)-C by 58%. Atorvastatin significantly reduced apo B, apo CIII, and apo E in VLDL by 40% to 46% and IDL-apo B by 66%. Atorvastatin also significantly reduced cholesterol in CM, light VLDL, and dense VLDL without consistently affecting triglyceride (TG) in these lipoproteins. Atorvastatin similarly reduced both light and dense LDL-apo B by 38%. LDL particle size in the HD patients significantly increased during atorvastatin treatment from 25.7 ± 0.4 to 26.2 ± 0.6 nm. High sensitive C-reactive protein (HS-CRP) was halved by atorvastatin decreasing from 0.08 ± 0.05 to 0.04 ± 0.03 mg/dL. Atorvastatin treatment did not affect the creatinine kinase level, and no classical adverse effects were observed during the study. These results suggest that atorvastatin is safe and effective for the management of dyslipidemia in patients with CFR who are receiving HD, which may help to suppress the development of atherosclerosis.

Elevated Serum Levels of C-Reactive Protein in Hemodialysis Patients

Serum C-reactive protein (CRP) levels were measured by nephelometry in 30 healthy subjects (controls) and in 99 patients with uncomplicated terminal uremia on conservative therapy (group 1, n = 30) or chronic hemodialysis (group 2, n = 69). Whereas there was no difference between controls and group 1, both the mean concentration of CRP and the incidence of elevated levels were significantly higher in group 2 in comparison with both controls and group 1. Moreover, the degree of increase in these patients was directly correlated with the duration of hemodialysis. The abnormality, therefore, is somehow related to chronic hemodialysis per se. From a practical standpoint, we concluded that this test cannot be recommended as an acute-phase reactant in this clinical setting.