Malnutrition-inflammation syndrome in a hemodialysis population: the influence of polymorphic IL-6-174 and IL-10-1082 genes.

AIM: To find out inflammation prevalence in hemodialysis patients and whether polymorphic gene IL-6-174 and IL-10-1082 had prominent factors in malnutrition inflammation syndrome. METHODS: A study on 81 patients who were on hemodialysis twice a week, 5 hours each session has been conducted. The subjects had no other co-morbidities and all of them used reprocessed diacetate cellulose dialyzers. RESULTS: It was obtained that CRP blood level (6.23+/- 5.57 mg/L), inflammation prevalence (23.5%), and malnutrition inflammation score (6.7) were lower compared with the data from Europe and the United States. Out of 64 patients examined, IL-6-174GG 95.31%, CC 3.13% and GC 1.56%, IL-1082AA 89.06%, GA 10.94%, but absence of GG genotype. Considering the scanty amount of allele C in IL-6-174 gene and G allele in IL-10-1082 gene, based on the statistic analysis performed, it did not reveal the influence of the difference in allele on the clinical manifestation. The proportion of these alleles were almost similar to that obtained in Korea, Japan and China, but it was different from that obtained in the US and in Europe. A very resolute impression was obtained in HD patients in Jakarta that IL-6-174GG gene was protective in nature whereas IL-10-1082 AA gene had a less considerable role. CONCLUSION: The prevalence of inflammation and malnutrition-inflammation parameters (CRP, malnutrition Inflammation Score) in our HD patients were lower than that reported in Western countries. This might be related to the low prevalence of IL-6-174C allele in our population.

Endotoxin in patients with terminal renal failure undergoing dialysis with re-processing dialyser.

AIM: to determine the level of endotoxin in the blood of patients with renal failure prior to and following hemodialysis using re-processing dialyser to know possibility of pyrogenic reactions in hemodialysis patients. METHODS: this study subjects consisted of 10 patients with terminal renal failure undergoing regular hemodialysis. The collected samples were then sent in frozen condition for endotoxin examination in Japan. The normal level of endotoxin in the blood was < 9.8 pg/ml based on standard E.Coli E.0111 endotoxin quantitatively measured using Limulus Amoebocyte lysate test (the endospecy test). Statistical analysis was performed using paired student test. RESULTS: Ten patients with terminal renal failure who were undergoing hemodialysis were obtained, consisting of 1 female and 9 males. The mean age was 55.5 years (SD 6.74), the mean hemoglobin level 7.26 g/dl (SD 2.19), mean white blood cell (WBC) count 8660/mm(3) (SD 3064.2), and mean albumin level 3.59 g/l (SD 247). The etiologies of renal failure were as follows: glomerulonephritis (GN) 30%, Diabetic nephropathy (DN) 20%, hypertension (HT) 10%, interstitial nephritis (IN) 10%, obstruction/infection (01) 10%, unknown (U) 10%. The mean duration of hemodialysis was 97.9 month (SD 54.86). The mean endotoxin level prior to hemodialysis (ET pre-hemodialysis) was 5.4 pg/dl (SD 8). CONCLUSION: we conclude that terminal renal patients who undergoing re-processing hemodialysis did not have endotoxemia both prior to and following hemodialysis unless if they associated with infection, or other complications.