Pro-inflammatory cytokines as potential predictors for intradialytic hypotension

Figures & data

Table 1. Demographic, clinical and biochemical data of the patients.

Characteristics	All (n = 390)	no-IDH (n = 318)	IDH (n = 72)	p Value
Demographic data
Age (year)	59.53 ± 14.34	59.37 ± 14.56	60.21 ± 13.43	0.655
Male (%)	238 (61%)	191 (60.1%)	47 (65.3%)	0.413
BMI (kg/m^2)	22.73 ± 3.44	22.68 ± 3.42	22.94 ± 3.54	0.554
Dialysis information
Normalized ultrafiltration rate (ml/h/kg)	10.42 ± 2.94	10.07 ± 2.94	11.71 ± 2.57	<0.001
IDWG, kg	2.35 ± 2.36	2.26 ± 2.59	2.67 ± 1.09	0.191
Preserved residual kidney function	13 (3.3%)	9 (2.8%)	4 (5.6%)	0.245
Duration of dialysis (months)	18.33 ± 8.28	18.99 ± 8.20	16.33 ± 8.39	0.193
Dry weight (kg)	60.59 ± 13.87	60.40 ± 13.93	61.32 ± 13.71	0.615
spKt/Vurea	1.22 ± 0.32	1.21 ± 0.28	1.23 ± 0.44	0.660
Peridialytic blood pressure
Predialysis-SBP (mmHg)	138.59 ± 17.60	137.01 ± 17.73	143.62 ± 16.31	0.005
Predialysis-DBP (mmHg)	77.18 ± 10.04	76.25 ± 9.83	80.11 ± 10.21	0.004
Postdialysis-SBP (mmHg)	128.60 ± 19.86	132.33 ± 18.91	116.76 ± 18.18	<0.001
Postdialysis-DBP (mmHg)	75.75 ± 10.94	77.35 ± 10.52	70.67 ± 10.77	<0.001
Biochemical data
Hemoglobin (g/L)	112.13 ± 16.47	116.85 ± 13.98	111.06 ± 16.82	0.007
Serum albumin (g/L)	36.75 ± 10.46	36.92 ± 10.21	36.06 ± 11.49	0.537
Serum prealbumin (g/L)	0.30 ± 0.14	0.30 ± 0.14	0.30 ± 0.15	0.882
Serum creatinine (μmol/L)	837.92 ± 416.17	836.70 ± 415.46	843.24 ± 422.10	0.905
iPTH (ng/L)	315.55 ± 267.74	309.55 ± 269.53	342.01 ± 259.90	0.354
Serum β2MG (mg/L)	37.86 ± 8.67	37.36 ± 8.76	40.03 ± 7.95	0.018
hs CRP (mg/L)	8.46 ± 15.03	8.24 ± 15.42	9.42 ± 13.28	0.548
EF (%)	59.44 ± 18.67	60.53 ± 17.72	56.06 ± 21.19	0.141
Inflammatory markers
TNF-α, pg/ml	50.27 ± 51.65	45.84 ± 40.59	69.82 ± 82.38	<0.001
IL-1β, pg/ml	84.82 ± 94.38	71.88 ± 82.57	145.18 ± 120.45	<0.001
IL-2R, U/ml	1368.87 ± 487.42	1352.36 ± 456.60	1441.36 ± 602.85	0.162
IL-6, pg/ml	65.12 ± 128.76	63.18 ± 128.39	73.25 ± 130.93	0.557
IL-8, pg/ml	850.74 ± 1522.37	789.18 ± 1498.88	1128.60 ± 1606.10	0.091
IL-10, pg/ml	9.71 ± 6.86	8.77 ± 5.15	12.18 ± 10.50	0.361
Medications
Antihypertensive medication type	2.15 ± 1.21	2.16 ± 1.23	2.11 ± 1.13	0.793
Antihypertensive medication dosage (tablets)	2.71 ± 1.87	2.75 ± 1.92	2.58 ± 1.72	0.486
Comorbidity
Hypertension (%)	296 (75.9%)	226 (71.1%)	70 (97.2%)	0.020
Diabetes mellitus (%)	72 (18.5%)	48 (15.1%)	24 (33.3%)	0.009
Cardiovascular disease (%)	44 (11.3%)	34 (10.7%)	10 (13.9%)	0.907
Cerebrovascular disease (%)	27 (6.9%)	23 (7.2%)	4 (5.6%)	0.343

Values are mean (SD) for continuous variables and % (n) for categorical variables. P-value, IDH vs no-IDH. BMI, body mass index; IDWG, interdialytic weight gain; SBP, systolic blood pressure; DBP, diastolic blood pressure; iPTH, intact parathyroid hormone; β₂MG, β₂-microglobin; hs CRP, high sensitive C-reaction protein; EF, ejection fraction; TNF-α, tumor necrosis factor-α; IL-1β, interleukin-1β; IL-2R, interleukin-2 receptor; IL-6, interleukin-6; IL-8, interleukin-8; IL-10, interleukin-10.

Table 2. Correlation between Inflammatory markers and intradialytic blood pressure.

	preSBP	preDBP	postSBP	postDBP
TNF-α, pg/ml
r	0.163**	0.169**	0.002	−0.026
P	0.005	0.004	0.976	0.653
IL-1β, pg/ml
r	0.189**	0.250**	−0.059	−0.012
P	0.008	<0.001	0.409	0.865
IL-2R, U/ml
r	0.037	−0.056	−0.009	−0.033
P	0.528	0.339	0.872	0.559
IL-6, pg/ml
r	0.068	0.143*	0.025	−0.007
P	0.258	0.017	0.667	0.905
IL-8, pg/ml
r	0.080	0.146*	−0.023	−0.024
P	0.168	0.011	0.681	0.669
IL-10, pg/ml
r	0.215	−0.161	−0.238	−0.440
P	0.501	0.617	0.433	0.132

**p < 0.01, *p < 0.05.

TNF-α, tumor necrosis factor-α; IL-1β, interleukin-1β; IL-2R, interleukin-2 receptor; IL-6, interleukin-6; IL-8, interleukin-8; IL-10, interleukin-10; preSBP, predialysis systolic blood pressure; preDBP, predialysis diastolic blood pressure; postSBP, postdialysis systolic blood pressure; postDBP, postdialysis diastolic blood pressure.

Figure 1. ROC curve of IL-1β and TNF-α for the onset of IDH.

Table 3. Logistic regression analysis for predialysis serum IL-1β and TNF-α on intradialytic hypotension.

Models	serum IL-1β (per 1 pg/ml increase)		serum TNF-α (per 1 pg/ml increase)
	OR (95%CI)	p Value	OR (95%CI)	p Value
Unadjusted	1.007 (1.004 ∼ 1.010)	<0.001	1.008 (1.003 ∼ 1.013)	0.003
Model 1	1.015 (1.006 ∼ 1.025)	0.002	1.014 (1.003 ∼ 1.025)	0.015
Model 2	1.015 (1.005 ∼ 1.025)	0.003	1.013 (1.002 ∼ 1.025)	0.024
Model 3	1.023 (1.006 ∼ 1.040)	0.008	1.015 (1.003 ∼ 1.027)	0.015
Model 4	1.031 (1.003 ∼ 1.061)	0.032	1.015 (1.002 ∼ 1.028)	0.028
Model 5	1.009 (1.000 ∼ 1.018)	0.039	1.014 (1.001 ∼ 1.028)	0.029

Model 1: adjusted for demographic data (age, sex, and body mass index) + dialysis information (interdialytic weight gain, residual renal function, dialysis vintage and single-pool Kt/V).

Model 2: adjusted for Model 1+ biochemical data (serum albumin, pre-albumin, creatinine and hemoglobin).

Model 3: adjusted for Model 2 + cardiac conditions (left ventricular ejection fraction) + comorbid conditions (history of primary hypertension, coronary heart disease, and diabetes).

Model 4: adjusted for Model 3 + predialysis blood pressure (predialysis systolic blood pressure and diastolic blood pressure).

Model 5: adjusted for Model 4 + antihypertensive medications.