[Inflammatory status in patients with end-stage renal disease: role of monocyte activation]

To study the association of monocyte activation and the inflammatory status in patients with end-stage renal disease (ESRD).

A total of 166 ESRD patients were recruited in the study, including 63 patients with pre-dialysis chronic renal failure (CRF), 16 undergoing continuous ambulatory peritoneal dialysis (CAPD) and 87 stable hemodialysis (HD) patients. Monocyte activation markers including plasma neopterin, tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, and plasma levels of acute phase proteins (APP) such as C-reactive protein (CRP) and serum amyloid A (SAA) were monitored using enzyme-linked immunosorbent assay (ELISA) kits.

The levels of neopterin, TNF-alpha, IL-1beta, CRP and SAA significantly increased in ESRD patients as compared with the normal controls (P<0.05 ). CRP and SAA in HD patients were higher than those in non-dialysis patients (P<0.05). The levels of CRP was closely correlated with neopterin, TNF-alpha and IL-1beta(r=0.287, 0.314, 0.262, P<0.05, respectively), and SAA with neopterin (r=0.306, P<0.05). These correlations remained significant after the values were adjusted for creatinine clearance in non-dialysis patients. Plasma contents of TNF-alpha, IL-1beta, CRP and SAA were significantly elevated after a single hemodialysis session (P<0.05).

Chronic inflammation occurs in patients with ESRD, which might be aggravated by hemodialysis. Activation of the monocytes might be involved in the pathogenesis of inflammation in uremia.