ABSTRACT
Vascular access [VA] dysfunction is a major clinical complication in the hemodialysis [HD] population and has a direct effect on dialysis outcome. Neointimal hyperplasia causes vascular stenosis and subsequent thrombosis, which result in vascular access failure in patients undergoing HD. interleukin10 [IL-10] and C-reactive protein are involved in this inflammatory process. The aim of this study was to investigate the relationship between vascular access failure and IL-10 level and explore the role of microinflammation in the VA dysfunction in pediatric patients on maintenance HD. Forty children receiving maintenance HD with arteriovenous fistula [AVF] in place or an artificial graft [AVG] or tunneled permanent catheter [TPC] were included for this study. They were divided into two groups: group 1 [n=26], children with good vascular access and group 2 [n=14] children with vascular access failure. Twenty healthy children were matched as controls for serum IL-10 and high sensitivity C-reactive protein [hs-CRP] levels. Clinical and laboratory data including serum IL-10 and hs-CRP levels were compared. Female gender, hypoproteinemia, and hypercholesterolemia were associated with vascular access failure. Serum IL-b in group 2 was significantly higher than those in group 1 and in controls [[45.68 +/- 29.62] pg/mi vs [31.07 +/- 22.01] pg/mi and [12.70 +/- 9.76] pg/mI, p<0.05, and p<0.001, respectively]. Serum hs-CRP in group 2 was significantly higher than those in group I and in controls [[5.27 +/- 5.44] mg/L vs [2.32 +/- 2.30] mg/L and [1.36 +/- 0.67] mg/L, P<0.01 and P<0.005, respectively]. Moreover, serum hs-CRP level was negatively correlated with IL-10 levels [r=-0.36, p=0.01].Also, serum hs-CRP level was negatively correlated with serum albumin [r=-0. 78, p=0.04], serum cholesterol [r=-0.91, p=0.002] and fractional shortening percentage on cardiac echo [r=-0.36,p=0.01]. Multiple regression analysis confirmed AVG and TPC, uremic cardiovascular disease, vascular access duration and WBC as factors independently influencing CRP levels. Patients with VA dysfunction have significant higher levels of serum IL-10 and hs-CRP. An altered immune response and microinflammation might contribute to vascular access failure. AVG and TPC have a higher degree of chronic inflammation than AVF