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Interleukin-6 predicts hypoalbuminemia, hypocholesterolemia, and mortality in hemodialysis patients.

Abstract
Low serum albumin and low serum cholesterol levels are among the most consistent predictors of mortality in patients with end-stage renal disease (ESRD) undergoing hemodialysis. Hypoalbuminemia is often interpreted as a marker of poor nutrition, but serum albumin and cholesterol levels can also be low as part of a cytokine-mediated acute-phase reaction to acute or chronic inflammation. Here we report the results from a 900-day prospective study designed to determine whether tumor necrosis factor-alfa (TNF-alpha) and interleukin-6 (IL-6) predict serum albumin and cholesterol levels and mortality in a group of 90 ambulatory, adult hemodialysis patients with no acute infection, hospitalization or surgery, and no known acquired immunodeficiency syndrome (AIDS), malignancy, or liver disease. Measurable levels of TNF-alpha and/or IL-6 were found in 89 of 90 patients. Significant relationships were found between TNF-alpha and IL-6 and the degree of hypoalbuminemia and dyslipoproteinemia. IL-6 was the strongest predictor of mortality in univariate and multivariate analysis, followed by age, albumin level, and body mass index (BMI). Although the cause of hypercytokinemia was not addressed in this study, the data support the view that hypoalbuminemia and hypocholesterolemia are negative acute-phase responses to inflammatory stimuli. These results suggest that efforts to identify the nature of the stimuli for cytokine production and to lower cytokine levels in hemodialysis patients might be effective in improving the survival of patients undergoing hemodialysis.
AuthorsR M Bologa, D M Levine, T S Parker, J S Cheigh, D Serur, K H Stenzel, A L Rubin
JournalAmerican journal of kidney diseases : the official journal of the National Kidney Foundation (Am J Kidney Dis) Vol. 32 Issue 1 Pg. 107-14 (Jul 1998) ISSN: 1523-6838 [Electronic] United States
PMID9669431 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Interleukin-6
  • Serum Albumin
  • Tumor Necrosis Factor-alpha
  • Cholesterol
Topics
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cholesterol (blood)
  • Female
  • Humans
  • Interleukin-6 (blood)
  • Kidney Failure, Chronic (blood, mortality, therapy)
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prospective Studies
  • Renal Dialysis (mortality)
  • Risk Factors
  • Serum Albumin (analysis)
  • Time Factors
  • Tumor Necrosis Factor-alpha (analysis)

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