The effect of etanercept on suppression of the systemic inflammatory response in chronic hemodialysis patients

Burl R Don, Kyoungmi Kim, J. Li, T. Dwyer, F. Alexander, George Kaysen

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background: Inflammation strongly predicts all-cause and cardiovascular mortality among dialysis patients. The negative acute-phase proteins, albumin and prealbumin are both inversely associated with mortality. Both albumin and prealbumin levels are decreased by inflammation.We carried out a pilot study to establishwhether treatmentwith the tumor necrosis factor-α receptor antagonist etanercept would be safe and result in improved levels of albumin and prealbumin in inflamed hypoalbuminemic (albumin < 3.8 g/dl, CRP > 8.0 mg/l) prevalent hemodialysis patients. Methods: We excluded patients who had infectious risk (hepatitis C or B positive, HIV positive, purified protein derivative (PPD) positive or having a history of tuberculosis, having a tunneled dialysis catheter) to find patients having both hypoalbuminemia and inflammation. Of 433 less than 6% met the inclusion criteria. 10 patients were randomized to receive etanercept or placebo twice weekly for 44 weeks. Results: There were no adverse infectious events. There was no significant difference for any of the measurements between the two groups. However there was a significant difference in the time-dependent effects of etanercept on prealbumin: increasing 20% in the etanercept group while decreasing in the placebo group. Conclusions: Administration of a TNF-α receptor antagonist appears safe in this selected population, despite the large increase in infectious risk observed in the dialysis patient population. The effect on surrogate markers of inflammation is small.

Original languageEnglish (US)
Pages (from-to)431-438
Number of pages8
JournalClinical Nephrology
Volume73
Issue number6
StatePublished - Jun 2010

Fingerprint

Renal Dialysis
Prealbumin
Albumins
Inflammation
Dialysis
Tumor Necrosis Factor Receptors
Placebos
Hypoalbuminemia
Hepatitis A
Mortality
Acute-Phase Proteins
Hepatitis C
Hepatitis B
Population
Etanercept
Tuberculosis
Catheters
Biomarkers
HIV
Proteins

Keywords

  • Albumin
  • IL-6
  • Inflammation-CRP
  • Prealbumin
  • sICAM
  • TNF-α
  • VEGF

ASJC Scopus subject areas

  • Nephrology

Cite this

The effect of etanercept on suppression of the systemic inflammatory response in chronic hemodialysis patients. / Don, Burl R; Kim, Kyoungmi; Li, J.; Dwyer, T.; Alexander, F.; Kaysen, George.

In: Clinical Nephrology, Vol. 73, No. 6, 06.2010, p. 431-438.

Research output: Contribution to journalArticle

@article{a713e3ed6fc440848edf233d0c8d1f6e,
title = "The effect of etanercept on suppression of the systemic inflammatory response in chronic hemodialysis patients",
abstract = "Background: Inflammation strongly predicts all-cause and cardiovascular mortality among dialysis patients. The negative acute-phase proteins, albumin and prealbumin are both inversely associated with mortality. Both albumin and prealbumin levels are decreased by inflammation.We carried out a pilot study to establishwhether treatmentwith the tumor necrosis factor-α receptor antagonist etanercept would be safe and result in improved levels of albumin and prealbumin in inflamed hypoalbuminemic (albumin < 3.8 g/dl, CRP > 8.0 mg/l) prevalent hemodialysis patients. Methods: We excluded patients who had infectious risk (hepatitis C or B positive, HIV positive, purified protein derivative (PPD) positive or having a history of tuberculosis, having a tunneled dialysis catheter) to find patients having both hypoalbuminemia and inflammation. Of 433 less than 6{\%} met the inclusion criteria. 10 patients were randomized to receive etanercept or placebo twice weekly for 44 weeks. Results: There were no adverse infectious events. There was no significant difference for any of the measurements between the two groups. However there was a significant difference in the time-dependent effects of etanercept on prealbumin: increasing 20{\%} in the etanercept group while decreasing in the placebo group. Conclusions: Administration of a TNF-α receptor antagonist appears safe in this selected population, despite the large increase in infectious risk observed in the dialysis patient population. The effect on surrogate markers of inflammation is small.",
keywords = "Albumin, IL-6, Inflammation-CRP, Prealbumin, sICAM, TNF-α, VEGF",
author = "Don, {Burl R} and Kyoungmi Kim and J. Li and T. Dwyer and F. Alexander and George Kaysen",
year = "2010",
month = "6",
language = "English (US)",
volume = "73",
pages = "431--438",
journal = "Clinical Nephrology",
issn = "0301-0430",
publisher = "Dustri-Verlag Dr. Karl Feistle",
number = "6",

}

TY - JOUR

T1 - The effect of etanercept on suppression of the systemic inflammatory response in chronic hemodialysis patients

AU - Don, Burl R

AU - Kim, Kyoungmi

AU - Li, J.

AU - Dwyer, T.

AU - Alexander, F.

AU - Kaysen, George

PY - 2010/6

Y1 - 2010/6

N2 - Background: Inflammation strongly predicts all-cause and cardiovascular mortality among dialysis patients. The negative acute-phase proteins, albumin and prealbumin are both inversely associated with mortality. Both albumin and prealbumin levels are decreased by inflammation.We carried out a pilot study to establishwhether treatmentwith the tumor necrosis factor-α receptor antagonist etanercept would be safe and result in improved levels of albumin and prealbumin in inflamed hypoalbuminemic (albumin < 3.8 g/dl, CRP > 8.0 mg/l) prevalent hemodialysis patients. Methods: We excluded patients who had infectious risk (hepatitis C or B positive, HIV positive, purified protein derivative (PPD) positive or having a history of tuberculosis, having a tunneled dialysis catheter) to find patients having both hypoalbuminemia and inflammation. Of 433 less than 6% met the inclusion criteria. 10 patients were randomized to receive etanercept or placebo twice weekly for 44 weeks. Results: There were no adverse infectious events. There was no significant difference for any of the measurements between the two groups. However there was a significant difference in the time-dependent effects of etanercept on prealbumin: increasing 20% in the etanercept group while decreasing in the placebo group. Conclusions: Administration of a TNF-α receptor antagonist appears safe in this selected population, despite the large increase in infectious risk observed in the dialysis patient population. The effect on surrogate markers of inflammation is small.

AB - Background: Inflammation strongly predicts all-cause and cardiovascular mortality among dialysis patients. The negative acute-phase proteins, albumin and prealbumin are both inversely associated with mortality. Both albumin and prealbumin levels are decreased by inflammation.We carried out a pilot study to establishwhether treatmentwith the tumor necrosis factor-α receptor antagonist etanercept would be safe and result in improved levels of albumin and prealbumin in inflamed hypoalbuminemic (albumin < 3.8 g/dl, CRP > 8.0 mg/l) prevalent hemodialysis patients. Methods: We excluded patients who had infectious risk (hepatitis C or B positive, HIV positive, purified protein derivative (PPD) positive or having a history of tuberculosis, having a tunneled dialysis catheter) to find patients having both hypoalbuminemia and inflammation. Of 433 less than 6% met the inclusion criteria. 10 patients were randomized to receive etanercept or placebo twice weekly for 44 weeks. Results: There were no adverse infectious events. There was no significant difference for any of the measurements between the two groups. However there was a significant difference in the time-dependent effects of etanercept on prealbumin: increasing 20% in the etanercept group while decreasing in the placebo group. Conclusions: Administration of a TNF-α receptor antagonist appears safe in this selected population, despite the large increase in infectious risk observed in the dialysis patient population. The effect on surrogate markers of inflammation is small.

KW - Albumin

KW - IL-6

KW - Inflammation-CRP

KW - Prealbumin

KW - sICAM

KW - TNF-α

KW - VEGF

UR - http://www.scopus.com/inward/record.url?scp=77952618631&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77952618631&partnerID=8YFLogxK

M3 - Article

C2 - 20497755

AN - SCOPUS:77952618631

VL - 73

SP - 431

EP - 438

JO - Clinical Nephrology

JF - Clinical Nephrology

SN - 0301-0430

IS - 6

ER -