Skip to main content
SpringerLink
Log in

Interleukin 6 is a better predictor of 5-year cardiovascular mortality than high-sensitivity C-reactive protein in hemodialysis patients using reused low-flux dialyzers

  • Nephrology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

A Correction to this article was published on 26 May 2020

This article has been updated

Abstract

Purpose

In this study, we focused on the role of elevated serum interleukin 6 (IL-6) concentration in predicting 5-year cardiovascular mortality in hemodialysis patients using low-flux dialyzer reuse.

Materials and methods

We measured serum IL-6 concentrations in 236 hemodialysis patients (138 males and 98 females) to predict 5-year cardiovascular mortality. We assessed the baseline demographics of all patients who had a mean age of 44 years and a median hemodialysis duration of 38.5 months. We divided all patients into two equal groups based on the serum IL-6 concentration: G1 (n = 118) with serum IL-6 concentration < 6.78 pg/L and G2 (n = 118) with serum IL-6 concentration ≥ 6.78 pg/L.

Results

After the 5-year follow-up, 45 patients died due to cardiovascular causes (19.1%). Lipid disorder, hemoglobin, serum albumin, β2-M, and IL-6 concentration were independent risk factors for predicting cardiovascular mortality during the 60-month follow-up in hemodialysis patients. Based on the Kaplan–Meier analysis, we realized that patients with a higher interleukin 6 concentration (G2) had a significantly higher cardiovascular mortality rate than patients in G1 (log-rank test p < 0.001). Serum IL-6 concentration was a better predictor of 5-year cardiovascular mortality than high-sensitivity C-reactive protein in hemodialysis patients using low-flux dialyzer reuse (AUC = 0.818; p < 0.001; cut-off value: 8.055 pg/mL, Se = 77.8%, Sp = 78.5%).

Conclusion

Serum IL-6 concentration was a better predictor of 5-year cardiovascular mortality than high-sensitivity C-reactive protein in maintenance hemodialysis patients using low-flux dialysis reuse.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Change history

  • 26 May 2020

    The article ���Interleukin 6 is��a��better predictor of��5-year cardiovascular mortality than��high-sensitivity C-reactive protein in��hemodialysis patients using reused low-fux dialyzers���.

References

  1. Heinrich PC, Behrmann I, Haan S et al (2003) Principles of interleukin (IL)-6-type cytokine signaling and its regulation. Biochem J 374(Pt 1):1–20. https://doi.org/10.1042/BJ20030407

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Su H, Lei CT, Zhang C (2017) Interleukin-6 signaling pathway and its role in kidney disease: an update. Front Immunol 21(8):405. https://doi.org/10.3389/fimmu.2017.00405(eCollection 2017.Review)

    Article  CAS  Google Scholar 

  3. Hénaut L, Massy ZA (2018) New insights into the key role of interleukin 6 in vascular calcification of chronic kidney disease. Nephrol Dial Transpl 33(4):543–548

    Article  Google Scholar 

  4. Carracedo J, Merino A, Nogueras S et al (2006) On-line hemodiafiltration reduces the proinflammatory CD14+ CD16+ monocyte-derived dendritic cells: A prospective, crossover study. J Am Soc Nephrol 17(8):2315–2321

    Article  CAS  PubMed  Google Scholar 

  5. Morad AA, Bazaraa HM, Abdel Aziz RE et al (2014) Role of online hemodiafiltration in improvement of inflammatory status in pediatric patients with end-stage renal disease. Iran J Kidney Dis 8(6):481–485

    PubMed  Google Scholar 

  6. Dounousi E, Koliousi E, Papagianni A et al (2012) Mononuclear leukocyte apoptosis and inflammatory markers in patients with chronic kidney disease. Am J Nephrol 36(6):531–536

    Article  CAS  PubMed  Google Scholar 

  7. Oh DJ, Kim HR, Lee MK et al (2013) Profile of human β-defensins 1,2 and proinflammatory cytokines (TNF-α, IL-6) in patients with chronic kidney disease. Kidney Blood Press Res 37(6):602–610

    Article  CAS  PubMed  Google Scholar 

  8. Cao H, Ye H, Sun Z et al (2014) Circulatory mitochondrial DNA is a pro-inflammatory agent in maintenance hemodialysis patients. PLoS One 9(12):e113179

    Article  PubMed  PubMed Central  Google Scholar 

  9. Babaei M, Dashti N, Lamei N et al (2014) Evaluation of plasma concentrations of homocysteine, IL-6, TNF-alpha, hs-CRP, and total antioxidant capacity in patients with end-stage renal failure. Acta Med Iran 52(12):893–898

    PubMed  Google Scholar 

  10. Tanaka T, Kishimoto T (2014) The biology and medical implications of interleukin-6. Cancer Immunol Res 2:288–294

    Article  CAS  PubMed  Google Scholar 

  11. den Hoedt CH, Bots ML, Grooteman MPC et al (2014) Online Hemodiafiltration reduces systemic inflammation compared to low-flux hemodialysis. Kidney Int 86:423–432

    Article  Google Scholar 

  12. Saddadi F, Alatab S, Pasha F et al (2014) The effect of treatment with N-acetylcysteine on the serum levels of C-reactive protein and interleukin-6 in patients on hemodialysis. Saudi J Kidney Dis Transpl 25(1):66–72

    Article  PubMed  Google Scholar 

  13. González-Espinoza L, Rojas-Campos E, Medina-Pérez M et al (2012) Pentoxifylline decreases serum levels of tumor necrosis factor alpha, interleukin 6 and C-reactive protein in hemodialysis patients: results of a randomized double-blind, controlled clinical trial. Nephrol Dial Transpl 27(5):2023–2028

    Article  Google Scholar 

  14. Daugirdas JT (1993) Second generation logarithmic estimates of single-pool variable volume Kt/V: an analysis of error. J Am Soc Nephrol 4:1205–1213

    CAS  PubMed  Google Scholar 

  15. Sarnak MJ, Bloom R, Muntner P et al (2015) KDOQI US commentary on the 2013 KDIGO clinical practice guideline for lipid management in CKD. Am J Kidney Dis 65(3):354–366

    Article  PubMed  Google Scholar 

  16. Carrero JJ, de Jager DJ, Verduijn M et al (2011) Cardiovascular and noncardiovascular mortality among men and women starting dialysis. Clin J Am Soc Nephrol 6:1722–1730

    Article  PubMed  Google Scholar 

  17. Tbahriti HF, Meknassi D, Moussaoui R et al (2013) Inflammatory status in chronic renal failure: the role of homocysteinemia and pro-inflammatory cytokines. World J Nephrol 2(2):31–37

    Article  PubMed  PubMed Central  Google Scholar 

  18. Jin K, Vaziri ND (2017) Elevated plasma cyclophillin a in hemodialysis and peritoneal dialysis patients: a novel link to systemic inflammation. Iran J Kidney Dis 11(1):44–49

    PubMed  Google Scholar 

  19. Tanaka T, Narazaki M, Kishimoto T (2014) IL-6 in inflammation, immunity, and disease. Cold Spring Harb Perspect Biol 6(10):a016295. https://doi.org/10.1101/cshperspect.a016295.Review

    Article  PubMed  PubMed Central  Google Scholar 

  20. Eleftheriadis T, Antoniadi G, Liakopoulos V et al (2007) Disturbances of acquired immunity in hemodialysis patients. Semin Dial 20(5):440–451

    Article  PubMed  Google Scholar 

  21. Jofré R, Rodriguez-Benitez P, López-Gómez JM et al (2006) Inflammatory syndrome in patients on hemodialysis. J Am Soc Nephrol 17(12 Suppl 3):S274–S280

    Article  PubMed  Google Scholar 

  22. Ramirez R, Carracedo J, Berdud I et al (2006) Microinflammation in hemodialysis is related to a preactivated subset of monocytes. Hemodial Int. 10(Suppl 1):S24–S27

    Article  PubMed  Google Scholar 

  23. Jeznach-Steinhagen A, Słotwiński R, Szczygieł B (2007) Malnutrition, inflammation, atherosclerosis in hemodialysis patients. Rocz Panstw Zakl Hig 58(1):83–88

    PubMed  Google Scholar 

  24. Fouque D, Pelletier S, Mafra D et al (2011) Nutrition and chronic kidney disease. Kidney Int. 80(4):348–357. https://doi.org/10.1038/ki.2011.118

    Article  CAS  PubMed  Google Scholar 

  25. Maraj M, Kuśnierz-Cabala B, Dumnicka P et al (2018) Malnutrition, inflammation, atherosclerosis syndrome (MIA) and diet recommendations among end-stage renal disease patients treated with maintenance hemodialysis. Nutrients. 10(1):E69. https://doi.org/10.3390/nu10010069

    Article  CAS  PubMed  Google Scholar 

  26. do Sameiro-Faria M, Ribeiro S, Costa E et al (2013) Risk factors for mortality in hemodialysis patients: two-year follow-up study. Dis Markers 35(6):791–798. https://doi.org/10.1155/2013/518945

    Article  PubMed  PubMed Central  Google Scholar 

  27. Ishii J, Takahashi H, Kitagawa F et al (2015) Multimarker approach to risk stratification for long-term mortality in patients on chronic hemodialysis. Circ J 79(3):656–663. https://doi.org/10.1253/circj.CJ-14-0915

    Article  CAS  PubMed  Google Scholar 

  28. Alves FC, Sun J, Qureshi AR et al (2018) The higher mortality associated with low serum albumin is dependent on systemic inflammation in end-stage kidney disease. PLoS ONE 13(1):e0190410. https://doi.org/10.1371/journal.pone.0190410

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Panichi V, Maggiore U, Taccola D et al (2004) Interleukin-6 is a stronger predictor of total and cardiovascular mortality than C-reactive protein in dialytic patients. Nephrol Dial Transpl 19:1154–1160

    Article  CAS  Google Scholar 

  30. Pecoits-Filho R, Barany P, Lindholm B et al (2002) Interleukin-6 is an independent predictor of mortality in patients starting dialysis treatment. Nephrol Dial Transpl 17:1684–1688

    Article  CAS  Google Scholar 

Download references

Acknowledgements

In this study, we had been strongly supported by clinical application funding of our local hospital and university to complete our research.

Funding

In this study, we had been strongly supported by clinical application funding of our local hospital and university to complete our research.

Author information

Authors and Affiliations

  1. Military Hospital 103, Hanoi, Vietnam

    Le Viet Thang, Nguyen Trung Kien, Do Manh Ha, Truong Quy Kien, Nguyen Thi Thuy Dung, Diem Thi Van, Nguyen Van Duc, Nguyen Thi Thu Ha & Pham Quoc Toan

  2. An Sinh Hospital, Ho Chi Minh, Vietnam

    Nguyen Duc Loc

  3. Bach Mai Hospital, Hanoi, Vietnam

    Nguyen Huu Dung

  4. Cho Ray Hospital, Ho Chi Minh, Vietnam

    Dao Bui Quy Quyen & Nguyen Minh Tuan

  5. 108 Military Central Hospital, Hanoi, Vietnam

    Vu Xuan Nghia

Authors
  1. Le Viet Thang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nguyen Duc Loc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nguyen Trung Kien
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nguyen Huu Dung
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dao Bui Quy Quyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nguyen Minh Tuan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Do Manh Ha
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Truong Quy Kien
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nguyen Thi Thuy Dung
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Diem Thi Van
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Nguyen Van Duc
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Nguyen Thi Thu Ha
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Pham Quoc Toan
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Vu Xuan Nghia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Le Viet Thang.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest, financial, or otherwise.

Ethics approval

This study was approved by the Ethical Committee of Vietnam Military 103 hospital (No.1939/QĐ/BVQY103), An Sinh Hospital (No.564/QĐ/BVAS), and Bach Mai Hospital (No.1231/QĐ/BVBM).

Human and animal rights

Animals did not participate in this research. All human research procedures were following the ethical standards of the committee responsible for human experimentation (institutional and national), and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent

Informed consent was obtained from all participants.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share the first co-author: Nguyen Duc Loc.

The original article has been revised due to retrospective Non Open Access.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Thang, L.V., Loc, N.D., Kien, N.T. et al. Interleukin 6 is a better predictor of 5-year cardiovascular mortality than high-sensitivity C-reactive protein in hemodialysis patients using reused low-flux dialyzers. Int Urol Nephrol 52, 1135–1142 (2020). https://doi.org/10.1007/s11255-020-02461-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-020-02461-7

Keywords

Search

Navigation