Abstract: FR-PO769
Are Cytokines and Body Composition Surrogate Markers for Outcomes in Hemodialysis Patients?
Session Information
- Dialysis: Inflammation and Infection
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Martins, Ana Rita Mateus, Davita, Óbidos, Portugal
- Moreira, Inês Costa, Davita, Óbidos, Portugal
- Weigert, Andre L., Davita, Óbidos, Portugal
Background
Obesity has been linked to better outcomes in hemodialysis (HD) patients (pts). Persistent inflammation, an important contributor to wasting, is associated with increased levels of tumor necrosis factor-alpha (TNF-α), hepcidin (Hpc) and soluble CD-163 (sCD163). TNF-α is a pro-inflammatory adipokine, sCD163 is a marker of macrophage activation and Hpc is the main regulator of hepcidin-ferroportin axis, all relevant inflammatory mediators. Our aim was to identify potential targets to minimize inflammation in HD pts.
Methods
Prospective cohort study with 160 prevalent HD pts. Baseline demographic data, blood biochemistry, serum inflammatory markers, comorbidities, anthropometric parameters and multifrequency bioimpedance were evaluated.
Results
In our cohort, 91 pts were male, mean age was 67 years, 40% had diabetes (DM) and average time on HD was 92 months. During the follow up (39±16 months), 38 pts died of cardiovascular (CV) events. Charlson comorbidity score was 4.4±2.3 and body index mass was 26.3±4.6 kg/m2. Pts were divided in two groups, according to their lean mass (LM): 51% had LM≥27%; no differences seen in age and time on HD between the two groups. Pts with LM≥27% had lower TNF-α (p=0.004), sCD163 (p=0.047), Hpc (p=0.038), hospital admissions (p=0.048) and had higher serum albumin (p=0.008). In a Kaplan Meier test, pts with higher LM had a better survival (139 vs 117 months; log rank 5.1; p=0.024). TNF-α was positively correlated with ferritin (p=0.005); sCD-163 was negatively correlated with serum albumin (p=0.02) and positively with CV events (p=0.025). Hpc was positively correlated with ferritin (p=0.018) and with cardiac failure (p=0,005) and negatively with triglycerides (p=.005). In a Cox hazards model, LM <27% was an independent predictor of mortality (HR=2.82; p=0.021; IC 95% 1.2-6.8), adjusted for age and DM.
Conclusion
We observed an association between a higher LM and better clinical outcomes and attenuation in inflammatory markers. Further studies of whether interventions that optimize body composition and interfere with the inflammatory profile of HD pts will improve survival are warranted.
Funding
- Commercial Support –