The erythrocyte sedimentation rate in end-stage renal failure

The effect of end-stage renal failure and the dialytic process on erythrocyte sedimentation rate (ESR) is largely unknown. We prospectively studied 60 stable patients with end-stage renal disease to determine the prevalence of elevated ESR in this population. ESRs were also measured immediately pre- and postdialysis in 48 hemodialysis patients. ESR was found to be elevated (greater than or equal to 25 mm/h, Westergren method) in 93% of patients with end-stage renal failure. Fifty-seven percent of patients had marked elevation of ESR (greater than 60 mm/h), while 20% had extreme increases in ESR (greater than or equal to 100 mm/h). In a linear models analysis, aging (P less than .02), anemia (P less than .01), and hypocalcemia (P less than .0001) correlated significantly with ESR elevation. Midweek BUN and creatinine, type and duration of dialysis, cause of renal failure, and serum albumin and total protein measurements did not correlate with ESR. In 48 stable in-center hemodialysis patients, mean predialysis ESR of 70 +/- 4 mm/h was not significantly different from mean postdialysis ESR of 72 +/- 5 mm/h. Retrospective chart review of available ESRs prior to initiation of any dialysis treatment also revealed significant elevation of ESR, mean 82 +/- 9 mm/h, in patients with renal disease not yet on dialysis. An upward trend in ESR during acute illness (74 +/- 9 to 95 +/- 8, N = 10) was observed. In a subpopulation of patients, fibrinogen correlated significantly with ESR while gamma-globulins did not. We conclude that measurement of ESR in end-stage renal failure has little clinical utility. Possible explanations for acceleration of ESR in this population are discussed.