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Yu J, Chen X, Li Y, Wang Y, Cao X, Liu Z, Shen B, Zou J, Ding X. Pro-inflammatory cytokines as potential predictors for intradialytic hypotension. Ren Fail 2021; 43:198-205. [PMID: 33459124 PMCID: PMC7833080 DOI: 10.1080/0886022x.2021.1871921] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Intradialytic hypotension (IDH) is a common complication in maintaining hemodialysis (MHD) patients. Immune activation might be part of the mechanisms. However, the association between pro-inflammatory cytokines and blood pressure (BP) has not been deeply explored. So we aim to evaluate the potential role of pro-inflammatory cytokines in IDH. Methods MHD patients starting hemodialysis before January 2016 were enrolled in our retrospective study. Patients' characteristics, laboratory results, and intradialytic BP were collected. IDH was defined as nadir systolic BP ≤ 90 mmHg during hemodialysis. The definition of IDH group was that those who suffered from more than one hypotensive event during one month after the enrollment (10% of dialysis treatments). Spearman correlation analysis and logistic regression were employed to explore the relationship between pro-inflammatory cytokines and IDH. Results Among 390 patients, 72 were identified with IDH (18.5%). High levels of serum tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were observed in the IDH group (p < 0.001). Both TNF-α and IL-1β positively correlated with predialysis BP (p < 0.01). Receiver operating characteristic curve (ROC) analysis was used to evaluate the diagnostic accuracy of serum IL-1β and TNF-α for IDH. The area under the curve of IL-1β was 0.772 (95% CI: 0.708-0.836, p < 0.01), and that of TNF-α was 0.701 (95% CI: 0.620-0.781, p < 0.01). After adjusting for patients' characteristics, biochemical parameters, comorbid conditions, predialysis BP, and medications, elevated TNF-α and IL-1β were still risk factors for IDH. Conclusion Pro-inflammatory cytokines (TNF-α and IL-1β) could be potential predictors for IDH.
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Affiliation(s)
- Jinbo Yu
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Xiaohong Chen
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Yang Li
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Yaqiong Wang
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Xuesen Cao
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Zhonghua Liu
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Bo Shen
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Jianzhou Zou
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Xiaoqiang Ding
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
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Chaudhary K, Khanna R. Renal Replacement Therapy in End-Stage Renal Disease Patients with Chronic Liver Disease and Ascites: Role of Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080802800202] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Chronic liver disease and cirrhosis account for several thousand deaths in the United States and often these patients have renal disease that progresses to end-stage renal disease (ESRD), necessitating renal replacement therapy. These patients provide significant challenges to their physicians, especially in the management of their ESRD with dialysis. ESRD patients with chronic liver disease and ascites are more difficult to manage on hemodialysis (HD) due to their hemodynamic status and risk of bleeding. Peritoneal dialysis (PD) offers them a viable alternative, along with a stable hemodynamic status and a lower risk of bleeding. The overall morbidity and mortality as well as the risk of peritonitis appear to be almost similar between cirrhotic and non-cirrhotic PD patients. In the absence of clinical trials comparing HD versus PD in such a population, and despite the limited clinical observations, the authors support PD as a viable and effective form of renal replacement therapy for patients with ESRD and associated chronic liver disease with cirrhosis and ascites.
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Affiliation(s)
- Kunal Chaudhary
- Division of Nephrology, University of Missouri Health Center
- Harry S. Truman VA Hospital, Columbia, Missouri, USA
| | - Ramesh Khanna
- Division of Nephrology, University of Missouri Health Center
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