Microinflammation is involved in the dysfunction of arteriovenous fistula in patients with maintenance hemodialysis

• Published in: Chinese medical journal 2008-11, Vol.121 (21), p.2157-2161
• Main Authors: Liu, Bi-cheng, Li, Li, Gao, Min, Wang, Yan-li, Yu, Ji-rong
• Format: Article
• Language: English
• Subjects: Adult; Aged; Arteriovenous Shunt, Surgical - adverse effects; C-Reactive Protein - analysis; Female; Humans; Immunohistochemistry; Inflammation - etiology; Interleukin-6 - blood; Male; Middle Aged; Renal Dialysis - adverse effects; 功能障碍; 动静脉瘘; 尿毒症; 血液透析
• ISSN: 0366-6999; 2542-5641
• DOI: 10.1097/00029330-200811010-00010

Background Vascular access （VA） dysfunction is a major clinical complication in the hemodialysis population and has a direct effect on dialysis outcome. This study was conducted to explore the role of microinflammation in the VA dysfunction in maintenance hemodialysis patients. Methods Forty-seven patients （male 35 and female 12） receiving maintenance hemodialysis were included for this study. They were divided into three groups： group 1 （n=15）, patients with initial hemodialysis and new arteriovenous fistula （AVF）; group 2 （n=18）, patients treated with hemodialysis for long term with well-functional VA; group 3 （n=14）, maintenance hemodialysis patients with VA dysfunction. Biochemical parameters and serum tumor necrosis factor-α （TNF-α）, interleukin 6 （IL-6） and monocyte chemoattractant protein-1 （MCP-1） were determined. High-sensitivity C-reactive protein （hs-CRP） was determined by latex-enhanced immuno-nephelometric method. Tissues of radial artery were taken from group 1 and group 3 for the histological study. Expression of CD68 and MCP-1 in the radial artery was determined by immunohistochemistry. Results Serum hs-CRP in group 3 was significantly higher than those in group 1 and group 2 （（7.40±2.42） mg/L vs （4.21±1.62） mg/L and （5.04±3.65） mg/L, P 〈0.01 and P 〈0.05, respectively）. Serum TNF-α in group 3 was significantly higher than those in group 1 and group 2 （（64.03±9.29） pg/ml vs （54.69±12.39） pg/ml and （54.05±7.68） pg/ml, P 〈0.05 and P 〈0.01, respectively）. Serum IL-6 in group 3 was also significantly higher than those in group 1 and group 2 （（70.09±14.53） pg/ml vs （56.43±10.11） pg/ml and （60.77±9.70） pg/ml, P 〈0.01 and P 〈0.05, respectively）. Patients in group 3 had a thicker internal layer of vessels than in group 1 （（0.356±0.056） mm vs （0.111±0.021） mm, P 〈0.01）. Expression of CD68 and MCP-1 in the fistula vessel walls in group 3 were much higher than those in group 1 （P 〈0.01）. Moreover, serum hs-CRP level was positively correlated with the neointimal hyperplasia, the expression of CD68 and MCP-1 in fistula vessel （P 〈0.01, respectively）. Conclusion Microinflammaton might be involved in the dysfunction of AVF in patients with maintenance hemodialysis.