Baylor College of Medicine, Houston, Texas, USA.
Kidney Int. 2009 Nov;76(10):1063-9. doi: 10.1038/ki.2009.303. Epub 2009 Aug 12.
Although hemodialysis catheters predispose to infection which, in turn, causes inflammation, we studied whether they induce inflammation independent of infection. We compared the level of the inflammatory marker C-reactive protein (CRP) in maintenance hemodialysis patients, comparing those dialyzed using a non-infected catheter to those using arteriovenous fistulas. All incident patients had catheters and fistula placement at dialysis initiation. In 35 patients the fistulas matured, the catheters were removed and the patients were evaluated at 6 months (catheter-fistula). These results were compared to 15 patients in whom the fistula did not mature and catheter use persisted for 6 months (catheter-catheter). There was a significant 82% reduction in the CRP level in the catheter-fistula group but a 16% increase in the catheter-catheter group at 6 months. The changes in CRP did not differ by gender, diabetes status, or by race, and was not correlated with a change in phosphorus, age, or urea reduction ratio at 1 month following hemodialysis initiation. Decreased CRP was associated with increased hemoglobin and albumin. Patients with persistent fistula use from dialysis initiation through 6 months had consistently low CRP levels over that time period. Our study shows that catheters might contribute to increased inflammation independent of infection, and supports avoidance of catheters and a timely conversion to fistulas with catheter removal.
尽管血液透析导管容易引起感染，而感染又会导致炎症，但我们研究了它们是否在不感染的情况下引发炎症。我们比较了维持性血液透析患者的炎症标志物 C 反应蛋白（CRP）水平，比较了使用未感染导管透析的患者与使用动静脉瘘的患者。所有新发病例在透析开始时均放置了导管和瘘管。在 35 例患者中，瘘管成熟，导管被移除，患者在 6 个月时进行评估（导管-瘘管）。将这些结果与 15 例瘘管未成熟且导管使用持续 6 个月的患者（导管-导管）进行比较。导管-瘘管组的 CRP 水平显著降低了 82%，而导管-导管组则增加了 16%。CRP 的变化与性别、糖尿病状态或种族无关，与透析开始后 1 个月磷、年龄或尿素清除率的变化无关。CRP 的降低与血红蛋白和白蛋白的增加有关。从透析开始到 6 个月期间持续使用瘘管的患者在此期间 CRP 水平持续较低。我们的研究表明，导管可能会在不感染的情况下导致炎症增加，并支持避免使用导管，并及时将导管转换为瘘管以去除导管。
