Comparison of Pan-immune Inflammatory Index in patients dialysed via catheter and fistula

Aims: Chronic kidney disease is a group of diseases associated with inflammatory processes, and the risk increases as the stage progresses. Increased inflammation in the disease is associated with mortality and morbidity, and diagnosis and treatment are very important. Arteriovenous fistula is recommended as the first choice for hemodialysis access. Some patients dialysed from catheters. We predict that catheters may cause a chronic inflammatory condition, and we planned this study to demonstrate this. Methods: 242 patients from dialysis patients who applied to Kırıkkale University Internal Medicine Clinic, Ankara Private Balgat Dialysis Center and Yozgat Bozok University Internal Medicine Clinic were included in the study; demographic data (age, gender), history data (chronic diseases, continuously used medications), data regarding hemodialysis duration, laboratory data (HGB, WBC, PLT, MPV, neutrophil, monocyte, lymphocyte, C-reactive protein, urea, creatinine, glomerular filtration rate) of the patients were recorded. Pan-Immune Inflammatory Index (PII) ((neutrophil count x platelet count x monocyte count)/lymphocyte count) were calculated. Differences between hemodialysis vascular access and PII values were statistically analyzed in SPSS package program. Results: According to hemodialysis vascular access routes, it was found that 182 (75.2%) of the patients had fistula dialysis, 60 (24.8%) had catheter dialysis and 85% of the individuals on catheter hemodialysis had permanent catheters, 15% had temporary catheters, 88% had jugular, and 12% had subclavian and femoral catheters. Inflammation levels were calculated with PII. While PII was calculated as 21125.33±39621.37 in patients undergoing hemodialysis through fistulas, it was calculated as 29745.24±50905.25 in patients undergoing hemodialysis through catheters (p=0.037*). In correlation analyses; A strong positive correlation was observed with lymphocyte, monocyte, neutrophil and platelet counts (respectively; 0.242**, 0.871**, 0.888**; 0.365**). A weak negative correlation was found with the duration of chronic kidney disease (-0.242*). Conclusion: Since there is no directly related parameter developed for analyzing the level of inflammation, there is a need for formulation methods. PII is also a tool used for this purpose. In our study, we analyzed in which cases the increased oxidative stress in hemodialysis is higher with PII and the parameters that trigger it, and as a result, we found higher inflammation in patients hemodialyzed from catheters compared to patients hemodialyzed from fistulas. We concluded that the increased oxidative stress in chronic kidney disease can be further removed from the fistula by hemodialysis or that oxidative stress caused by foreign bodies such as catheters may be higher. For a more definitive decision, further examination is needed by evaluating before and after hemodialysis and examining individuals with chronic kidney disease who are on hemodialysis and those who are not.