BACKGROUND: The mortality rate is high among end-stage renal disease (ESRD) patients, and recent evidence suggests that this may be linked to inflammation. The activity of interleukin-6 (IL-6) and its soluble receptor (sIL-6R) are markedly up-regulated in ESRD patients, and plasma IL-6 levels predict outcome in haemodialysis (HD) patients. However, it has not been established whether elevated plasma IL-6 also predicts outcome in ESRD patients treated by peritoneal dialysis (PD), and how it relates to the data on HD patients. The predictive power of sIL-6R levels on outcome is also unknown in this patient population. METHODS: To determine whether or not plasma IL-6 and sIL-6R predict patient survival, we studied 173 ESRD patients (62% males, 53+/-1 years of age) near the initiation of dialysis treatment (99 PD, 74 HD patients). The patients were followed for a mean period of 3.1+/-0.1 years (range 0.1-7.1 years) and were stratified at the start of dialysis treatment according to age, gender, presence of cardiovascular disease, malnutrition (determined by subjective global assessment), diabetes mellitus, and IL-6 and sIL-6R plasma levels. RESULTS: A significantly different (P<0.0001) mortality rate was observed in different groups when patients were divided into quartiles according to IL-6 levels. Furthermore, the same differences were observed, less notably however, for sIL-6R (P<0.05). When patients were stratified according to IL-6 quartiles and analysed separately according to the different initial treatment groups, a similar profile of survival was observed for PD (P<0.01) and HD (P<0.05) patients. In a Cox proportional hazard model adjusting for the impact of age, malnutrition, diabetes mellitus and male gender, log IL-6 values were independently associated with poor outcome (P<0.05). CONCLUSIONS: The present study demonstrates that the strong predictive value of elevated IL-6 levels for poor outcome in ESRD patients is similar in both HD and PD patients starting treatment.
BACKGROUND: The mortality rate is high among end-stage renal disease (ESRD) patients, and recent evidence suggests that this may be linked to inflammation. The activity of interleukin-6 (IL-6) and its soluble receptor (sIL-6R) are markedly up-regulated in ESRDpatients, and plasma IL-6 levels predict outcome in haemodialysis (HD) patients. However, it has not been established whether elevated plasma IL-6 also predicts outcome in ESRDpatients treated by peritoneal dialysis (PD), and how it relates to the data on HDpatients. The predictive power of sIL-6R levels on outcome is also unknown in this patient population. METHODS: To determine whether or not plasma IL-6 and sIL-6R predict patient survival, we studied 173 ESRDpatients (62% males, 53+/-1 years of age) near the initiation of dialysis treatment (99 PD, 74 HDpatients). The patients were followed for a mean period of 3.1+/-0.1 years (range 0.1-7.1 years) and were stratified at the start of dialysis treatment according to age, gender, presence of cardiovascular disease, malnutrition (determined by subjective global assessment), diabetes mellitus, and IL-6 and sIL-6R plasma levels. RESULTS: A significantly different (P<0.0001) mortality rate was observed in different groups when patients were divided into quartiles according to IL-6 levels. Furthermore, the same differences were observed, less notably however, for sIL-6R (P<0.05). When patients were stratified according to IL-6 quartiles and analysed separately according to the different initial treatment groups, a similar profile of survival was observed for PD (P<0.01) and HD (P<0.05) patients. In a Cox proportional hazard model adjusting for the impact of age, malnutrition, diabetes mellitus and male gender, log IL-6 values were independently associated with poor outcome (P<0.05). CONCLUSIONS: The present study demonstrates that the strong predictive value of elevated IL-6 levels for poor outcome in ESRDpatients is similar in both HD and PDpatients starting treatment.
Authors: Alberto Ortiz; Ziad A Massy; Danilo Fliser; Bengt Lindholm; Andrzej Wiecek; Alberto Martínez-Castelao; Adrian Covic; David Goldsmith; Gültekin Süleymanlar; Gérard M London; Carmine Zoccali Journal: Nat Rev Nephrol Date: 2011-11-01 Impact factor: 28.314
Authors: William R Zhang; Amit X Garg; Steven G Coca; Philip J Devereaux; John Eikelboom; Peter Kavsak; Eric McArthur; Heather Thiessen-Philbrook; Colleen Shortt; Michael Shlipak; Richard Whitlock; Chirag R Parikh Journal: J Am Soc Nephrol Date: 2015-04-08 Impact factor: 10.121
Authors: Mehdi Rambod; Rachelle Bross; Jennifer Zitterkoph; Deborah Benner; Juhi Pithia; Sara Colman; Csaba P Kovesdy; Joel D Kopple; Kamyar Kalantar-Zadeh Journal: Am J Kidney Dis Date: 2008-12-13 Impact factor: 8.860
Authors: James B Wetmore; David H Lovett; Adriana M Hung; Galen Cook-Wiens; Jonathan D Mahnken; Saunak Sen; Kirsten L Johansen Journal: Nephrology (Carlton) Date: 2008-09-25 Impact factor: 2.506