Effect of vascular access types on inflammation in hemodialysis patients

Chronic inflammation is a common entity among chronic renal failure patients, especially in patients undergoing dialysis. In recent years various reasons such as advanced age, longer life time and diabetes mellitus, increased the use of central venous permanent catheters as vascular access. Neutrophil gelatinase-associated lipocalin (NGAL) is a member of lipocalin family and released from many tissues like neutrophil, stomach, kidney and colon.In this study we aimed to investigate the relationship between the different vascular access types used in dialysis patients and with stage 3-4 chronic renal failure patients with inflammation markers such as high sensitive CRP (hs-CRP), Interleukin -6 (IL-6) and Tumor Necrosis Factor-Alpha (TNF- ?).Study population was consisted of total 120 patients in four different groups and age ranged between 18-70 years. Group I 30 patients undergoing dialysis with central venous permanent catheter, Group II 30 patients undergoing dialysis by arterio- venous fistula, Group III 30 patients having chronic renal failure (Stage 3-4) but not on routine dialysis and Group IV 30 healthy age and gender matched volunteers. Hemogram, biochemical assays and also levels of ferritin, IL-6, hs-CRP, TNF-? and NGAL were evaluated in all patients.IL-6, TNF-?, hs-CRP, NGAL and ferritin levels were high and albumin was low in patients undergoing dialysis via central venous permanent catheter. When compared between groups I, II and III there was no significant difference in IL-6 levels (p>0,05), however hs-CRP and TNF-? differed significantly (p<0,01). NGAL levels measured in Group I was 5.8 times higher than the control group.This is the first study investigating the relationship between vascular access way and inflamation markers and NGAL. NGAL was correlated with inflammation markers. The presence of central venous permanent catheter in hemodialysis patients is increasing the inflammation. Therefore, as the first choice of vascular access should be AVF, should not be central venous permanent catheters.Key words: Hemodialysis, central venous permanent catheter, inflammation, Neutrophil gelatinase-associated lipocalin