A Study Of Microinflammation And Vascular Access Dysfunction In Maintenance Hemodialysis Of Uremic Patients

Objective: It has been proved microinflammation exists in the uremic patients and it cannot be completely eliminated through sufficient hemodialysis. Inflammation is positively correlate with small artery lesions of coronary heart diseases, and is also one of them independent risk factors. Hemodialysis vascular access (VA) dysfunction is a common and major clinical complication in the hemodialysis population and has a direct effect on dialysis outcome. But we have little knowledge about microinflammation and vascular access dysfunction in uremic patients. Our present work is based on former knowledge of vascular access dysfunction in uremic patients. To explore the role of microinflammation in the vascular access dysfunction in uremic patients and to investigate its clinical significance through the connection of clinical and pathological information.Methods: Forty-seven patients were selected from maintenance hemodialysis. Among them there were thirty-five males and twelve females. All patients were belonged to stage five of chronic kidney disease and their creatinine clearances (Ccr) were all smaller than 10ml/min. These patients were all in stable conditions and with no acute inflammatory reactions and other active diseases during the experiment periods. Experiments subgroups were as follow: initial VA group (15 patients), VA well-function group (18 patients) and VA dysfunction group (14 patients). Biochemical indicators were observed in these three groups. Serum TNF-α, IL-6 and MCP-1 were determined by ELISA and high-sensitivity CRP (hs-CRP) was determined by latex-enhanced immunonephelometric method. Segments of radial arteries were obtained from uremic subjects of the initial VA group and VA dysfunction group. The intimal thickness of both radial arteries was calculated by common pathology HE staining. Expression of CD68 and MCP-1 in the radial arteries walls were determined by immunohistochemistry.Results: Serum hs-CRP of the VA dysfunction group was significantly higher those in the initial VA group and VA well-function group (7.40±2.42mg/L vs 4.21±1.62mg/L,5.04±3.65mg/L; the former P<0.01, the latter P<0.05). Serum TNF-αof the VA dysfunction group was significantly higher than those in the initial VA group and VA well-function group ( 64.03±9.29pg/ml vs 54.69±12.39pg/ml,54.05±7.68pg/ml, the former P<0.05,the latter P<0.01).