End-Stage Renal Disease :: Health, Diseases, Hemodialysis Patients

Introduction Patients with End-Stage Renal Disease (ESRD) had higher anemia rate than general population (1). Several studies considered inflammatory markers as predictors of outcome in patients with ESRD and in one of them which was performed on 25000 HD patients, neutrophil count combined with low lymphocyte count were independent predictor of outcome in hemodialysis patients (2). In some of other studies elevated level of C-reactive protein was accounted for higher mortality rate in HD patients (3). In a European study, CRP were presented as one of the uremic syndrome futures and 50% of patients have CRP level >8mg/l and 75% of them had CRP level >3.4mg/l (3). Anemia related increase serum level of pro-inflammatory factors with poor treatment outcomes in HD patients (4). There is relationship between anemia, inflammation and oxidative stress level. Serum level of hemoglobin was increased during 2-3 days after inflammatory response to infection. Inflammation also active macrophages and remove old erythrocytes from the serum of HD patients (5). According to findings of previous studies, ESRD is one of the states that increase pro-inflammatory cytokines and in some of them interleukins (IL) 1, 4 and 6 and tumor necrosis factor (TNF) were 8-10 times higher than general population (6). Statine agents can reduce serum level of CRP in HD patients and decline their need to Epoetin for management of anemia (7). Serum CRP level more than 5-10 mg/l is associated with cardiovascular events and statine agents due to reduce CRP level might decline mortality of HD patients and improve their cardiovascular outcome. Measurement of Serum level of C reactive protein (CRP) in hemodialysis (HD) patients with anemia and their response to lovastatin is aim of our study. Material and methods One hundred fifty hemodialysis patients in Imam Khomeini and Amiralam hospital during 2004 were participated in our randomized clinical trial. Hemodialysis patients had three sessions per week hemodialysis plan with Polysulphone and Hemophane dialysis filters and bicarbonate as dialysis solution. Our study was approved in ethical committee of Tehran medical university and informed consent was obtained from each patient. Our inclusion criteria Our inclusion criterias were more than hemodialysis patients with six months hemodialysis and Hs-CRP higher than 10 mg per liter, without tumors, chronic respiratory disorders, iron deficiency anemia, hypothyroidism, diabetic foot ulcer, total cholesterol more than 200 mg/dl, abnormal liver tests, immunosuppressive, beta blocker and statine usage, and active infection in recent three months.