CHRONIC INDUCTION OF C-REACTIVE PROTEIN BY HEMODIALYSIS, BUT NOT BY PERITONEAL-DIALYSIS THERAPY

Objective: Evaluation of the inflammatory activity in patients on chro nic peritoneal dialysis (PD) and patients on chronic hemodialysis (HD) in comparison to patients with chronic renal insufficiency without di alysis treatment and healthy volunteers. Design: Open, nonrandomized p rospective study. Setting: Nephrology Department, including HD and PD therapy in a university hospital. Patients: Twenty-four patients on ch ronic PD, 21 patients on chronic HD therapy using a cuprophan dialyzer , 16 patients with chronic renal insufficiency without dialysis treatm ent, and 33 healthy volunteers; 8 additional patients before and after initiation of chronic HD therapy. All patients and controls were with out infection or immunosuppressive therapy. Main Outcome Measures: As a marker of the inflammatory activity in the different patient groups, C-reactlve protein (CRP) was measured serially using a sensitive, enz yme-linked, immunosorbent assay in order to detect values below the de tection limit of standard assays. Results: All patient groups had CRP levels higher than the normal controls (p < 0.01). Patients on HD had CRP levels significantly higher than PD patients (p < 0.01) whose leve ls were comparable to patients without dialysis therapy. Accordingly, longitudinal measurements before and after initiation of chronic HD sh owed a significant increase in CRP levels after the beginning of HD tr eatment (p < 0.04). Conclusions: The results suggest that induction of the inflammatory activity is lower during PD compared to HD, since st imulation by the dialyzer membrane, dialysate buffer, or bacterial fra gments in the dialysate is avoided. This observation might indicate a possible lower risk of long-term complications in patients with PD.