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Circulating Bacterial-Derived DNA Fragments and Markers of Inflammation in Chronic Hemodialysis Patients

Maurizio Bossola^*, Maurizio Sanguinetti, Donata Scribano, Cecilia Zuppi, Stefania Giungi^*, Giovanna Luciani^*, Riccardo Torelli, Brunella Posteraro, Giovanni Fadda, and Luigi Tazza^*

^* Istituto di Clinica Chirurgica, Servizio Emodialisi; Istituto di Microbiologia; and Istituto di Biochimica, Università Cattolica del Sacro Cuore, Roma, Italia

Correspondence: Dr. Maurizio Bossola, Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8-00168 Roma, Italia. Phone: +39-06-30155485; Fax: +39-06-30155491; E-mail: maubosso{at}tin.it

Background and objectives: Bacterial-derived DNA fragments (BDNAs) have been shown to be present in dialysis fluid, to pass through dialyzer membranes, and to induce IL-6 (IL-6) in mononuclear cells. The present study aimed at assessing the eventual presence of BDNAs in the blood of hemodialysis (HD) patients and if this is associated with markers of chronic inflammation.

Design, setting, participants, & measurements: Fifty-eight HD patients and 30 controls were included in the study. A blood sample was collected from a peripheral vein and from the central venous catheter (CVC) or the arteriovenous fistula (AVF) and examined for presence of BDNAs by 16S rRNA gene PCR amplification, bacterial growth, and measurement of C-reactive protein and IL-6. Thirty minutes after the start of HD, a sample of dialysis fluid was collected before the entry into and at the exit of the dialyzer and examined for presence of BDNAs.

Results: Controls had negative blood cultures and absence of blood BDNAs. All HD patients had negative blood cultures, but in 12 (20.7%), BDNAs were present in the whole blood. In five of the latter, BDNAs were also found in the dialysis fluid. C-reactive protein serum levels (mg/L) were significantly higher in patients with than in those without BDNAs. Likewise, IL-6 serum levels (pg/ml) were significantly higher in patients with BDNA than in those without.

Conclusions: Circulating BDNAs are associated with higher levels of C-reactive protein and IL-6 in HD patients.