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Microinflammation versus inflammation in chronic renal failure patients.

To the Editor: In their study, Pupim et al1 show that patients with end-stage renal failure (ESRF) in the highest quartile of C-reactive protein (CRP) and interleukin-6 (IL-6) before hemodialysis (HD) initiation have a significant decrease in the serum level of both markers after 12 months of HD treatment. The baseline levels for IL-6 and CRP in these subgroups were about 58 pg/mL and 62 mg/L, respectively. As the authors note, no exclusion criteria were used for enrollment in the study. These CRP and IL-6 serum levels are probably indicative of an infection or other cause of "real inflammation" (trauma, malignancy, etc.). In the referred study microinflammation investigation is warranted. It is low-grade inflammation that is correlated to atherosclerosis or other threatening processes. Recently, a cut-off for CRP (10 mg/L) indicative for inflammation versus microinflammation was established for the general population2. We also found a similar cut-off for CRP and IL-6 (9.5 mg or pg/L) indicative for an inflammatory clinical event, in a group of HD patients3. Possibly this cut-off is higher in other HD patients, but, as the results in the majority of studies with ESRF patients show, it seems improbable to be higher than 15 mg/L for the CRP.