Inflammatory Markers in Patients with ESKD on Maintenance Hemodialysis, Hemodiafiltration (HDF), and Early Postkidney Transplant Patients and Their Relation to Quality of Life (SGA Score)

Abstract

Background: Patients with end-stage renal disease (ESRD) needing renal replacement therapy is estimated about 7 million worldwide.Hemodiafiltration (HDF) yields an increased overall solute clearance compared with hemodialysis (HD).Kidney transplantation offers an improved quality of life in comparison to dialysis.In ESRD,inflammation has become recognized.High-sensitivity C-reactive protein (Hs-CRP) is a biomarker of inflammation which plays a key role in atherosclerosis.A growing amount of information is emerging about MicroRNAs in the regulation of renal fibrosis.We studied inflammatory markers and quality of life (QOL) in different renal replacement modalities. Methods: A cross-sectional study was conducted on 75 patients;25 patients with ESRD on HD,25 patients with ESRD on HDF and 25 early post-renal transplant patients. Moreover,10 healthy controls were added to get to the normal gene expression of the studied MicroRNA ‘serum miR-223’.Inflammatory biomarkers (Hs-CRP, serum miR-223) were withdrawn and subjective global assessment (SGA) was applied. Results: Hs-CRP was significantly higher in HD patients; median 14.2 (7.4 - 16.9 mg/L) than HDF; median 6.3 (4.1 - 14.3 mg/L) and post renal transplant patients median 5.2 (3.3 - 8.6 mg/L) (P= 0.003).Serum miR-223 showed down-regulation in dialysis patients; HD and HDF.This down-regulation improved in post renal transplant patients (approaching readings of the healthy control group) with highly significant differences between dialysis and post-transplant groups (P= 0.000).Post renal transplant patients had better quality of life;SGA score A (normal)= 100%, in comparison with dialysis groups of patients.Moreover, when comparing SGA in both dialysis modalities,HDF group of patients had better quality of life as 76% of them had normal nutritional status (SGA score A) in comparison with the HD group who had only 32% patients with SGA score A (normal) with highly significant statistical differences between the 3 groups (P= 0.000). Conclusion: Kidney transplantation offers improved quality of life for ESRD patients in comparison to dialysis.Moreover,for patients on dialysis,HDF modality demonstrates a beneficial effect on QOL in comparison to HD.