NDT Advance Access originally published online on August 31, 2004
Nephrology Dialysis Transplantation 2004 19(11):2810-2815; doi:10.1093/ndt/gfh475
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Nephrol Dial Transplant Vol. 19 No. 11 © ERA-EDTA 2004; all rights reserved
Original Article
Interleukin-18 is a strong predictor of hospitalization in haemodialysis patients
1 Department of Internal Medicine, Far Eastern Memorial Hospital, 2 National Taiwan University Hospital, Taipei, Taiwan and 3 Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan
Correspondence and offprint requests to: Dr Kuan-Yu Hung, Department of Internal Medicine, Far Eastern Memorial Hospital, No. 21, Sect. 2, Nan-Ya South Road, Pan Chiao, Taipei 220, Taiwan, ROC. Email: d820612{at}ha.mc.ntu.edu.tw
Background. Morbidity and mortality rates are high among patients with end-stage renal disease (ESRD), and recent evidence suggests that this may be linked to inflammation. Current research has also demonstrated the crucial involvement of interleukin-18 (IL-18) in inflammation. In agreement, the activity of IL-18 has been markedly up-regulated in ESRD patients. However, it has not been established whether elevated plasma IL-18 predicts outcome in haemodialysis (HD) patients.
Methods. To determine whether plasma IL-18 predicts overall hospitalization, we studied 184 ESRD patients (62% males, 58.5±1.0 years of age) undergoing maintenance HD treatment. The patients were followed for 12 months and were stratified by the tertiles of plasma IL-18 levels. Classic factors, such as age, body mass index, duration of HD, nutritional and inflammatory parameters, co-morbidity, dialysis adequacy, and lipid status were entered into a Cox regression model to predict hospitalization. The Kaplan–Meier method was used to analyse the cumulative proportion of hospitalization-free events.
Results. Significantly different hospitalization days and frequencies (P<0.05) were observed when patients were divided according to tertiles of plasma IL-18 levels. Patients were stratified according to IL-18 tertiles and analysed separately according to the hospitalization-free period. In the Kaplan–Meier model, the upper tertile of IL-18 had the highest probability of a hospitalization event during the entire follow-up period (P log rank = 0.027). In the Cox proportional hazard model, the relative risk for first hospital admission for each increase in Ln IL-18 (pg/ml) concentration was associated with a 1.709 (95% CI, 1.114 to 2.620; P = 0.014) increase in the risk for future hospitalization events.
Conclusions. The present study demonstrated a strong predictive value of elevated IL-18 levels for poor outcome in HD patients.
Keywords: hospitalization; haemodialysis; interleukin-18
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