Inflammatory markers in end-stage renal disease patients on maintenance hemodialysis, hemodiafiltration (HDF), early post-renal transplant patients, and their relation to quality of life (SGA Score)

Abstract

Chronic kidney disease (CKD) is associated with malnutrition-inflammation-atherosclerosis (MIA) syndrome, persistent inflammation, and protein-energy wasting, which adversely affect nutritional status and quality of life. High-sensitivity C-reactive protein (hs-CRP) is a marker of systemic inflammation, while circulating microRNA-223 (miR-223) represents a novel epigenetic biomarker in CKD. This study investigated associations between hs-CRP, miR-223, and nutritional status (SGA score) in 75 end-stage kidney disease (ESKD) patients: 25 on hemodialysis (HD), 25 on hemodiafiltration (HDF), and 25 kidney transplant recipients, with 10 healthy controls for miR-223 reference. hs-CRP was significantly higher in HD patients (median 14.2 mg/L) compared with HDF (6.3 mg/L) and transplant recipients (5.2 mg/L, p=0.003). miR-223 expression was downregulated in dialysis groups but improved post-transplant, approaching healthy controls. Nutritional status differed significantly: 100% of transplant recipients were well-nourished (SGA Class A) compared with 76% in HDF and 32% in HD. In conclusion, kidney transplantation is associated with lower inflammatory burden and better nutritional status than dialysis modalities. Reduced miR-223 in dialysis patients and its improvement after transplantation suggest a protective role in CKD pathophysiology.