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Abstract: SA-PO1034

Effect of Interleukin-6 on All-Cause Mortality in Renal Dialysis Patients: A Systematic Review

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Holmes, Matthew James vaughton, University Hospital North Midlands, Stoke-on-Trent, United Kingdom
  • Elphick, Emma H., University Hospital North Midlands, Stoke-on-Trent, United Kingdom
  • Tabinor, Matthew, University Hospital North Midlands, Stoke-on-Trent, United Kingdom
  • Ali, Hatem, University Hospital North Midlands, Stoke-on-Trent, United Kingdom
  • Davies, Simon J., University Hospital North Midlands, Stoke-on-Trent, United Kingdom
  • Lambie, Mark, University Hospital North Midlands, Stoke-on-Trent, United Kingdom
Background

In patients post myocardial infarction, there is strong evidence from a large randomized controlled trial of an anti-inflammatory that the association between chronic inflammation and mortality is causal. We aimed to assess how consistent with a causal interpretation is the evidence linking chronic inflammation and mortality in end stage kidney disease. We undertook a systematic review of the association between Interleukin-6 levels and mortality in patients undergoing dialysis.

Methods

MEDLINE, Embase, PsychInfo and Cochrane databases were searched for prospective cohort studies and randomised controlled trials published up until December 2018. Two independent reviewers selected papers reporting relationships between all-cause mortality and systemic inflammation as defined by IL-6, in adult dialysis patients. Demographics, all-cause mortality, and cardiovascular mortality data were extracted and reviewed in a descriptive fashion.

Results

Of the 1,324 papers initially identified, 28 were selected for the review with a total of 7,490 participants (range 50 to 959). Despite significant heterogeneity in analytical approach, higher levels of IL-6 were associated with worse all-cause mortality in 26 of the papers. In 18 of the 26 studies results were from multivariable survival analyses adjusting for age (65%), gender (58%), diabetes (46%), dialysis duration (35%), albumin (46%), smoking (27%), and CRP (27%). All 6 of the 25 studies assessing cardiovascular mortality, all of which reported multivariable analysis, found that IL-6 levels were predictive.

The remaining two studies reported all-cause mortality in relation to variants in the -174G/C IL-6 polymorphism. Both studies found that the CC variant was associated with increased mortality compared to the GG variant (hazard ratio 1.71 [95%CI 0.98-1.78] and 3.58 [1.41-9.07, p<0.01]), although the relationship between the polymorphism and levels of IL-6 is less clear.

Conclusion

Systemic inflammation, assessed by plasma IL-6 concentration, is consistently associated with increased all-cause and cardiovascular mortality in adult dialysis patients. This is consistent with, but not proof of, a causal association.