Acute and chronic inflammation in pediatric patients receiving hemodialysis

Objectives To assess chronic and acute inflammation in children receiving maintenance hemodialysis. Study design To assess markers of acute inflammation, serum levels (ELISA) of the cytokines tumor necrosis factor (TNF)-alpha interleukin (IL)-1beta, IL-10, and IL-6, 3 to 5 mL, of serum was obtained from 13 pediatric patients (mean patient weight, 37.0 +/- 15.2 kg; meanage, 14.6 +/- 4.6years) before and 30 minutes and 24 hours after a routine midweek hemodiallysis treatment session. Chronic inflammation was assessed by serum C-reactive protein (CRP) levels. Results Early-response cytoldnes TNF-alpha at 30 minutes (5.84 +/- 0.94 to 9.67 +/- 0.92 pg/mL; P =.002) and 24 hours (5.84 +/- 0.94 to 9.54 +/- 1.05 pg/mL; P =.008) and IL-1beta at 30 minutes (17.19 +/- 2.00 to 26.17 +/- 1.12 pg/mL; P =.001) and 24 hours (17.19 +/- 2.00 to 23.01 +/- 1.13 pg/mL; P =.02) increased significantly after hemodialysis. Later-response cytok-ines IL-10 and IL-6 activation was not significant. CRP levels were elevated in 10 of 13 patients (mean, 14.7 +/- 9.5mg/L; range, 7.2-38.8 mg/ L) and correlated with dialysis vintage. Baseline IL-6 and IL-10 levels correlated with dialysis vintage and correlated negatively with eqKt/V. Conclusions We observed a chronic inflammatory state in pediatric hemodialysis patients not related to the hemodialysis treatment but rather dialysis vintage and hemodialysis adequacy. We suggest that either more frequent dialysis or enhanced cytokine clearance may ameliorate the chronic inflammatory state observed in pediatric patients receiving hemodialyslis.