hsCRP, sICAM-1 and TAFI in hemodialysis patients: linking inflammation and hypofibrinolysis to cardiovascular events.

Background/aims: Growing evidence suggests that inflammation, oxidative stress and hypofibrinolysis may have a pivotal role in the high prevalence of cardiovascular disease (CVD) in chronic kidney disease (CKD) patients. This study aims to investigate the association of these processes with the incidence of CVD in hemodialysis (HD) patients and to examine the modulating effect of oral L-arginine in HD patients having CVD.

Methods: Blood malondialdehyde (MDA), highly sensitive C-reactive protein (hsCRP), soluble intracellular adhesion molecule-1 (sICAM-1) and thrombin-activatable fibrinolysis inhibitor (TAFI) levels were measured in 12 healthy controls and in 62 CKD patients divided into 15 renal impairment, 21 HD, and 26 HD+CVD. Of the latter, 15 patients received oral L-arginine (15 g/day, 5 g t.i.d.) for 1 month.

Results: MDA, hsCRP, sICAM-1 and TAFI were significantly elevated in renal impairment patients. HD and HD+CVD experienced higher levels, but only MDA and TAFI were significantly higher in HD+CVD than HD patients. Only MDA was significantly reduced by 41% after L-arginine intake.

Conclusion: This study demonstrates the association of inflammation and hypofibrinolysis with hemodialysis especially in patients with CVD. We found no added therapeutic value for L-arginine at the used dose and duration to ameliorate these cascades of events.