Influence of initiation of maintenance hemodialysis on biomarkers of inflammation and oxidative stress

Background. Chronic inflammation and oxidative stress are highly prevalent in patients with chronic kidney disease and end-stage renal disease (ESRD). These conditions contribute to high mortality rates associated with cardiovascular disease, the leading cause of death in this patient population. To our knowledge, no prospective studies have examined how initiation of maintenance hemodialysis (MHD) affects biomarkers of inflammation and oxidative stress status. Methods. This was a prospective cohort study evaluating time-dependent changes in C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-10 (IL-10), and protein carbonyl content before and after initiation of MHD over a 12-month period. Fifty incident hemodialysis patients [57.6+/-17.2 years, 60% male, 38% Caucasians, 32% insulin-dependent diabetes mellitus (IDDM) were studied, with 50 healthy subjects for comparison. The study variables were assessed before the initial outpatient hemodialysis treatment, and every 3 months thereafter for 12 months. Results. At baseline, CRP, IL-6 and carbonyl content levels were significantly higher in MHD patients compared with healthy subjects,(P<0.001 for each). After initiation of MHD, there were no significant changes in any of the study variables. Patients who initiated MHD with the highest levels of all the study variables had a significant decrease over the next year, but the variables were still higher than normal at the end of the 12-month study period. Conclusion. Our data show that initiation of MHD does not have significant influence on plasma concentrations of CRP, IL-6, and IL-10, as well as plasma protein carbonyl content. These findings suggest that MHD is ineffective in controlling inflammation and oxidative stress in uremia.