Relationship Between Inflammation And Uraemic Pruritus In Maintenance Haemodialysis Patients

Objective To investigate the correlation between inflammation and uraemic pruritus inmaintenance hemodialysis patients.Methods Thirty-nine maintenance hemodialysis patients and twelve healthy controlswere recruited to the study. HD patients were inquired the severity of their pruritus byvisual analog scale (VAS). In HD patients, blood samples were taken before and afterhemodialysis during the inquiry day. Inflammatory factors: Interleukin（IL）-2, IL-6, IL-10,tumor necrosis factor （TNF） were measured by Cytometric Bead Array(BDTM).Results Pre-and after-dialysis IL-2, IL-6, IL-10, TNF and pre-dialysis hsCRP weresignificantly higher in HD patients than that in healthy controls, and there were nodifferences in age and sex. Spearman rank correlation analysis and liner regression analysisshowed that pre-dialysis IL-2was positively correlated with VAS score（β=0.586，t=4.399，F=19.354，P<0.01）. HD patients were divided into3groups according to VAS score, nopruritus (VAS=0,38%), mild to moderate pruritus (VAS=1~5,41%), severe pruritus(VAS>5,21%). Pre-and after-dialysis IL-2were significantly higher in patients with severepruritus than that with no pruritus.Conclusion There is a high prevalence of uraemic pruritus in maintenance hemodialysispatients. Inflammation plays an important role in the pathogenesis of uraemic pruritus. IL-2 influences uraemic pruritus of HD patients. Objective This study investigated the effect of arteriovenous fistula blood flow（Qa）dynamics on inflammation and cardiovascular diseases in maintenance hemodialysispatients.Methods Thirty maintenance hemodialysis patients bearing an native AVF and twelvehealthy controls were recruited into the study. Qa and cardiac output (CO) were measuredby means of Transonic Hemodialysis Monitor HD02. In HD patients, predialysis bloodsamples were taken before Qa mornitoring.HsCRP was measured by immunoturbidimetry（KYOMA）. Inflammatory factors:IL-2, IL-6, IL-10, TNF were measured by CytometricBead Array(BDTM). Cardiovascular diseases morbidity was mornitored prospectively over anineteen months period.Results The serum IL-6, IL-10, TNF and hsCRP significantly inceased in HD patientsthan that in healthy controls〔2.38（1.86~4.69）vs1.14（0.27~1.18）pg/ml，P<0.01；1.47（1.19~2.10） vs1.04（0~1.23）pg/ml，P<0.01；1.33（1.05~1.56）vs0.54（0~1.24）pg/ml，P <0.05；4.90（1.58~7.45）vs1.50（0.63~1.90）mg/l，P=0.01〕, and there wereno statistically significant age and sex differences. During the follow-up period,6patients (20%) developed at least one episode of cardiovascular event. Qa, the serum IL-6andhsCRP levels were significantly higher in patients with CVD than that without〔（1120±192）vs（893±189）ml/min，P<0.05；4.86（2.96~7.85）vs2.20（1.80~3.10）pg/ml，P<0.01；11.7（53.83~31.53）vs4.45（1.05~6.68）mg/l，P<0.05〕.We assessed the independentrisk factors of CVD morbidity by binary logistic regression analysis. It demonstrated thatserum IL-6was an independent and stronger risk factor for CVD morbidity〔HR=1.943，P=0.02，95%CI （1.110~3.402）〕. Spearman rank correlation analysis and liner regressionanalysis showed that Qa was positively correlated with serum IL-6（β=0.492，P<0.01）.Path analysis suggested that Qa contributed to CVD mortality via the increase of serumIL-6.Conclusion AVF blood flow monitoring is important to maintenance HD patients.IL-6is an independent risk factor of CVD in maintenance HD patients. Over a certain range,AVF blood flow dynamics increases cardiovascular disease morbidity in HD patients via itspromotion of IL-6production.