Bologa RM, Levine DM, Parker TS, Serur D, Stenzel KH, Rubin A, Cheigh JS
High cytokine levels may mediate the high mortality of hemodialysis patients with low albumin and cholesterol
Am Soc Nephrol
J Am Soc Nephrol (abstract) (Nov) 6:573 1995

These investigators found measurable concentrations of the inflammatory cytokines IL-6 and TNF-alpha in most of the predialysis serum samples of 94 stable adult ambulatory hemodialysis patients. They also found a significant negative correlation between levels of these cytokines and both serum albumin and serum cholesterol. In the first year of follow-up there were 17 deaths each associated with relatively high TNF-alpha and IL-6 levels and with low albumin and cholesterol levels. Since inflammatory cytokines have been shown to inhibit synthesis of lipoproteins and albumin in vitro, the authors suggest that these products of inflammation mediate the hypoalbuminemia and hypocholesterolemia and associated mortality in patients with ESRD.

Comment: This study suggests a mechanism for the association between mortality and the acute phase response in ESRD. Cytokines have been known to initiate the acute phase response in vivo and cytokine levels have been reported to be elevated in hemodialysis patients. Although the numbers are small, this study shows a correlation between mortality and cytokine elevation. Direct interference with cytokine release or the subsequent acute phase response with specific inhibitors, for example, may have clinical benefits but it may be better to attack the more fundamental (and in some cases mysterious) process that led to the generation of cytokines. (Depner)

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Am Soc Nephrol
CRF: Problem Areas : Outcomes (Morbidity, Mortality)
CRF by organ system : Nutrition