Effect of a Hemodialysis Session on Markers of Inflammation and Endotoxin.

IF 2.6 Q3 IMMUNOLOGY

International Journal of Inflammation Pub Date : 2022-03-10 eCollection Date: 2022-01-01 DOI:10.1155/2022/8632245

Shyam Dheda, David A Vesey, Carmel Hawley, David W Johnson, Magid Fahim

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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 (postHD_48hrs).

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) postHD_48hrs. 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.

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血液透析对炎症和内毒素标志物的影响。

背景:由于传统心血管危险因素的增加，接受血液透析(HD)治疗的人心血管发病率和死亡率更高。然而，非传统风险因素的作用，如炎症，已经越来越被认识到。这种炎症的起源仍然难以捉摸，一个假定的原因是循环细菌内毒素水平升高。方法:在本研究中，检测了30例成人HD患者和10例无肾脏疾病的健康人的血清内毒素和炎症生物标志物(包括高敏c反应蛋白(hsCRP)、白细胞介素-6 (IL-6)、白细胞介素-1β (il -1β)、铁蛋白和肿瘤坏死因子(TNF))的浓度。在接受HD治疗的患者中，分别在透析前(HD前)、透析后(thd后)和透析后48小时(thd后48小时)采集样本。结果:90份样品中仅检出1份内毒素。透析前后血清hsCRP、il - 1β、il - 6水平无显著差异。血清TNF水平从hd前的30.9 (8.0,39.5)pg/mL显著下降至hd后的13.9 (8.5,17.3)pg/mL (p=0.002)， 2天后又回升至27.37 (14.5,35)pg/mL (p < 0.001)。铁蛋白从HD前的1153 ng/mL(782, 1458)增加到HD后的1313 ng/mL (657, 1638) (p < 0.001)，然后又下降到1186 ng/mL (754, 1597) (p=0.66)。与对照组相比，接受HD治疗的患者hsCRP水平显著升高[6.16 mg/L (2.1, 16.8) vs. 1.1 mg/L (0.81, 3.63) p=0.015]， il - 1β [1.5 pg/mL (0.05, 2.51) vs. 0.5 pg/mL (1.81, 2.95) p≤0.001]，铁蛋白[1153 (782,1458)vs. 132.9 (111, 257) ng/mL p≤0.001]，但il - 6 [6.15 pg/mL (4.82, 9.12) vs. 7.49 pg/mL (4.56, 10.39)， p=0.77]和TNF [27.35 pg/mL±17.48 vs. 17.87 pg/mL±12.28,p < 0.12]。总之，HD患者的炎症生物标志物水平升高，这与内毒素血症(罕见)或透析过程无关。

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