Monday, October 31, 2011

In the News: Initial access type in dialysis patients and inflammation?

Fistula, graft or catheter placement, which causes more inflammatory response?? No one knows.
The authors conducted a prospective observational study in an incident HD population. C-reactive protein (CRP), interleukin-6 (IL-6), and interferon-γ-induced protein (IP-10) were measured before and at 6-time points after access placement for 1 year. 40 patients were studied with no differences in baseline characteristics. The study found that patients who initiate hemodialysis with a perm cath or an AVG have a heightened state of inflammation, which may contribute to the excess 90-day mortality after HD initiation.
This study is unique in that baseline cytokine values were obtained before first access placement and prior to HD initiation, so some comparison could have been done.  The prospective study design allowed for recording all intercurrent events, which were included in the adjusted analysis. 

Interestingly, this is showing us that any "foreign" object in our body is going to raise the inflammatory markers. AVF doesn't really involve an foreign body and perhaps these results reflect that more than the procedure. The numbers are small and larger studies are needed to clearly clarify this point

The full study is at

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