|Elshamaa MF et al.|
Serum Interleukin-10 Levels and Microinflammation in Vascular Access Failure in Egyptian Children on Hemodialysis
Journal of Clinical and Basic Cardiology 2009; 12 (1-4): 18-23
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Keywords: Hämodialyse, interleukin-10, Kardiologie, hemodialysis, interleukin-10, microinflammation, uremia
outcome. Neointimal hyperplasia causes vascular stenosis and subsequent thrombosis, which result in vascular access failure in patients undergoing hemodialysis. Interleukin-10 (IL-10) and C-reactive protein are involved in this inflammatory process. The aim of this study was to investigate the relationship between vascular access failure and IL-10 levels and to explore the role of microinflammation in the VA dysfunction in maintenance pediatric hemodialysis patients. Methods: Forty children receiving maintenance hemodialysis with an arteriovenous fistula in place or an artificial graft (AVG) or a tunneled permanent catheter (TPC) were included in this study. They were divided into two groups: group 1 (n = 26): children with good vascular access, and group 2 (n = 14): children with vascular access failure. Twenty healthy children were matched as controls for serum IL-10 and high-sensitivity C-reactive protein (hs-CRP) levels. Clinical and laboratory data including serum IL-10 and hs-CRP levels were compared. Results: Female gender, hypoproteinemia, and hypercholesterolemia were associated with vascular access failure. Serum IL- 10 in group 2 was significantly higher than in group 1 and in controls (45.68 ± 29.62 pg/ml vs 31.07 ± 22.01 pg/ml and 12.70 ± 9.76 pg/ml; p < 0.05, and p < 0.001, respectively). Serum hs-CRP in group 2 was significantly higher than in group 1 and in controls (5.27 ± 5.44 mg/l vs 2.32 ± 2.30 mg/l and 1.36 ± 0.67 mg/l, p < 0.01 and p < 0.005, respectively). Moreover, serum hs-CRP levels were negatively correlated with IL-10 levels (r = –0.36; p = 0.01). Also, serum hs-CRP levels were negatively correlated with serum albumin (r = –0.78; p = 0.04), serum cholesterol (r = –0.91; p = 0.002) and fractional shortening percentage on cardiac echo (r = –0.36; p = 0.01). Multiple regression analysis confirmed AVG and TPC, cardiovascular disease, vascular access duration, and WBC as factors independently influencing CRP levels. Conclusion: Patients with VA dysfunction have significantly higher levels of serum IL-10 and hs-CRP. An altered immune response and microinflammation might contribute to vascular access failure. AVG and TPC have a higher degree of chronic inflammation than AVF.