Association of Nutrition Status and Pro-Inflammatory Cytokines in Patients with Peritoneal Dialysis at King Chulalongkorn Memorial Hospital, Thailand

Abstract

Patients undergoing peritoneal dialysis (PD) are often malnourished. Elevated pro-inflammatory cytokine levels found during dialysis process may be a factor worsening nutritional status. This study was conducted to evaluate the relationship of the nutritional status and the levels of pro-inflammatory cytokines in patients undergoing PD at King Chulalongkorn Memorial Hospital, Bangkok. Anthropometry, biochemical measurement, and subjective global assessment (SGA) were performed. The levels of interleukin (IL)-6 and tumor necrosis factor (TNF)-a in plasma and spent dialysate were evaluated. There were 26 patients (13 males and 13 females) in this study. Based on the SGA scores, 13 patients (50.0%) were mildly-to-moderately malnourished, 2 (7.7%) were severely malnourished, and 11 (42.3%) were well nourished. The subjects with hypertension showed significantly higher concentration of plasma IL-6 compared to the subjects without hypertension (21.61 ± 9.42 vs 13.94 ± 0.35 pg/ml; p < 0.05). Plasma IL-6 concentration had positive correlations with body mass index (r_s = 0.433, p = 0.027) and mid-arm circumference (r_s = 0.487, p = 0.012). In addition, plasma IL-6 and TNF-a concentrations negatively correlated with dietary protein intake (r_s = -0.414, p = 0.044 and r_s = -0.462, p = 0.022 respectively). This study demonstrated that patients with PD tended to have malnutrition, and certain pro-inflammatory cytokines were observed in their plasma and spent dialysate. Early detection of malnutrition and of such cytokines could be beneficial in planning for therapeutic management.