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Causes of inflammation and inflammation variability in prevalent hemodialysis and peritoneal dialysis patients. Sunna Snaedal‐Jónsdóttir. Division of Renal Medicine sunna.snaedal‐firstname.lastname@example.org Background Patients with chronic kidney disease stage (CKD) 5, and especially dialysis patients, have a high morbidity and mortality from premature cardiovascular disease. This can only in part be explained by traditional risk factors such as hypertension and hyperlipidemia. In the recent years focus has been drawn to untraditional risk factors, such as inflammation and increased oxidative stress. It has been shown that patients with end stage kidney disease are prone to inflammation compared to the general population and that inflammation is an independent risk factor for death from cardiovascular disease. Until now studies on the subject have been performed using single measurements of inflammatory markers, mostly C‐reactive protein (CRP). In the acute evaluation of dyspnea and cardiac failure N‐terminal proBNP (NT‐proBNP) is being frequently used for non‐renal patients. The usefulness of this marker in CKD patients, and above all in dialysis patients, has been uncertain. The concentration in blood of NT‐proBNP is increased in CKD probably because of a combination of a decreased renal clearance and an increase in fluid volume. In dialysis patients NT‐proBNP can be up to 100‐fold compared to normal values, i.e. the interpretation of such extreme values is uncertain. Aims and hypothesis Does variation in inflammatory markers have any relation to comorbidity in dialysis patients and if so can repeated measurements of inflammation give better prognostic information than single measurements? Are cardiac markers relevant in the prognostic evaluation of dialysis patients, including survival? Does the variation of these markers coincide with variation of inflammation? Which inflammatory markers are most strongly related to comorbidity/mortality and which underlying factors are most linked to inflammation in this patient group? Is the variation of inflammatory markers different in patients treated with hemodialysis as compared to peritoneal dialysis? Study plan In the first paper we described how inflammation varies over time in and in between patients on hemodialysis. We analysed whether there is a relation between variation in inflammation and other patient related factors such as comorbidity and intercurrent clinical events. In the second study we will focus on markers of cardiac disease and relate them to inflammation. Since little is known about how useful these markers are in hemodialysis patients the aim is to see how well the markers adhere to congestive heart failure and ischemic heart diesase in these patients. In the third study we aim to further look into whether hsCRP, IL‐6, IL‐10 and TNFα differ in variability in the same patient and in between patients. In the fourth study the aim is to measure markers of inflammation and cardiac disease in peritoneal dialysis patients in the same way as done in paper 1 and 2 for hemodialysis patients.
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