Plasma C-reactive protein in haemodialysis

In recent years, acute phase reactants have been reevaluated as not merely biochemical markers of inflammation but also as active modulators of the in flammatory response. C-reactive protein - which is normally present in seru m in only trace amounts, but whose concentration may rise markedly with inf lammatory stimuli - was the first human acute phase protein discovered. It is now clear that cytokines are the major mediators of acute phase protein induction: interleukin-6 currently is felt to be the principal cytokine inf luencing C-reactive protein acute changes. Several studies have provided co nvincing evidence that among normal men, base-line serum levels of C-reacti ve protein are predictive of future myocardial infarction and ischemic stro ke. The relevance of acute phase reactants in morbidity and mortality of ha emodialysis patients has not been fully elucidated until now: in fact a few studies have implicated C-reactive protein in malnutrition, EPO-resistance , as a cardiovascular risk factor and as a marker of chronic stimulation in haemodialysis. The authors suggest the hypothesis of the occurrence of lon g-term complications in patients exposed to contaminated dialysate and sugg est that back-filtration may induce a chronic, slowly developing inflammato ry state that may be abrogated by avoiding backfiltration of contaminated d ialysate.