Markers of Inflammation in the Stenosis of Hemodialysis Vascular Access

Kim, Su Hyun; Kim, Seung Jung; Kang, Duk Hee; Choi, Kyu Bok; Yoon, Kyun Il

Abstract

BACKGROUND: Histologically, vascular access stenosis is similar to the atherosclerotic lesion such as neointimal hyperplasia. However, the pathogenesis is not completely understood. The development of Inflammation and atherogenesis in hemodialysis population has been well recognized and is known as the malnutrition-inflammation-atherosclerosis (MIA) syndrome. We, therefore, examined the relationship between the vascular access stenosis and proinflammatory molecules in hemodialysis patients
METHODS
Seventy-two regularly dialyzed patients were observed and the serum levels of the proinflammatory cytokines (IL-6, TNF-alpha and INF-gamma) were measured by ELISA. Patients were followed until the earliest date of death, modality change or loss to follow up.
RESULTS
Vascular access stenosis was developed in thirty-five patients, and their mean duration of access survival was 22.7+/-37.6 months. In thirty-seven patients, vascular access remained patent during the study period (mean follow up; 70.9+/-46.6 months). In patients with autologous AV fistula, multivariate Cox regression analysis showed a significant contribution of INF-gamma to vascular access stenosis (Hazard ratio 1.024, p=0.044). In patients with AV graft, there was no significant relation between inflammatory cytokines and graft stenosis. There were positive correlations between the level of TNF-alpha and ferritin, and between transferrin and albumin. CRP and ferritin were negatively correlated with albumin and transferrin.
CONCLUSIONS
Markers of inflammation were significantly associated with nutrition. And INF-gamma, one of the inflammatory cytokines, was related to the vascular access stenosis.