Evaluation of Hemodialysis Patients’ Tumor Marker

Evaluation of Hemodialysis Patients Tumor MarkerCEA tumor marking level associates comorbidity of hemodialysis patientsPurposes Hemodialysis (HD) impresss serum concentration of biomarkers. However, it remains unreadable ab forth the effect of HD on the levels of biomarkers, and efficacy of biomarkers in HD. The aim of this regard is to evaluate the effects of HD on commonly utilise tumor markers.Methods A summation of 28 unselected patients (22 men, 6 women) with end-st develop nephritic disease (ESRD), treated with maintenance HD, were enrolled in this study. GOT and tumor markers CA-153, CA-125, and CEA are measured.Results The mean age was 57.6 12.6 years, HD duration was 51.0 34.0 months. Tumor marker CEA level is correspond to Charlsons score of HD patients, levels of CA153 and CA125 are not fit to age, duration of dialysis and Charlsons score. GOT level is correlatived to age, and Charlsons score. Mean care for of CEA level (5.94.0 ng/ml compared to normal value of 3 ng/ml for non-smoker and 5 ng/ml for smoker) is larger than normal value. Levels of CA153 (13.311.6 U/ml), CA125 (35.238.9 U/ml) and GOT value (20.48.9 U/L) f all(prenominal) in normal trope.Conclusions Concentration of CEA tumor marker is correlated with Charlsons score which strongly correlated with HD outcome. GOT value is correlated with age and Charlsons score which implies liver function drop in long bound HD patients.Keywords biomarkers, End-Stage Renal Disease, evaluation, hemodialysis, CEA.IntroductionHemodialysis (HD) is widely used for kidney failure patients who may represent a variety of underlying causes, including diabetes, hypertension, and glomerulonephritis. The dialysis membrane in artificial kidney tube filtrates out small molecules especially for small molecular weight proteins (i.e., et. al. shows that cancer-free HD humanity demonstrated significantly lower PSA compared to controls 8. Here we examine the serum level of commonly used molecular biomarkers , i.e., CA-153, CA125, CEA, and GOT of HD patients.Patient and materialsStudy subjectsExperiments performed in this study complied with the current laws and regulations in Taiwan, Republic of China. All procedures are followed by the ethnical guideline and approved by Kaohsiung Armed Forces Hospital committee, Taiwan. A total of 28 persons between the ages of 37 and 76 years with end-stage renal disease, receiving dialysis treatment three times per week, were enrolled in a prospective study in March 2008. Dialysis was carried out using a Nikkiso DBB-22B dialysis machine with 4 hours session. Dialyzer with APS 18MD (Asahi Kasei, Osaka, Japan, polysulfone membrane, surface area 1.8 m2, in vitro clearances for urea, 198 ml/min for QB-200 ml/min). Blood flow rate was place at 200 ml/min. Patients with vascular success insufficiency which cant reach required blood flow rate was excluded. Ultrafiltration rate (51285 ml/h) was adjusted according to the patients needs. The flow and tempera ture of the dialysate was 500 ml/min and 37oC, respectively. Vascular access was either via an arterio-venous fistula (sixteen treatments), graft (nine treatments), or a permanent catheter (three treatment). Serum CA-153, CA125, CEA, GOT levels were measured before and immediately later on HD using low-flux membrane.Blood/serum collectionSerum samples were collected from HD patients during and after the course of HD treatment. 5 ml blood was collected in EDTA tube. The serum were then stored in 4oC and processed within 12 hours. The serum samples were centrifuged at 2000 rpm for 10 min earlier to splitting into aliquots and stored at -20oC.Laboratory methodsThe serum levels of CA-153, CA125, CEA and GOT were measured with Abbott Axsym analyzer (Abbott Laboratories, Abbott Park, III). The reference ranges of the markers were CA-153, 0-31.3 U/ml CA-125, 0-35 U/ml CEA, 0-3 ng/ml for non-smoker, and 0-5 ng/ml for smoker GOT, 0-32 U/L.Statistical analysisThe data reported are means s tandard deviations (SD). Pearson correlation coefficient (r) was used for analyses of linear associations. Because the concentrations of serum tumor markers were not normally distributed, significance of differences was assessed by Wilcoxon Matched-Pairs Signed-Ranks Test. The level of statistical significance was always set at PResultsBaseline demographic and clinical dataWe examine 28 patients, of which 22 were men and 6 were women. The baseline demographic and clinical data are summarized in control panel 1. All patients are diagnosed as end-stage renal failure. The mean age was 57.8 12.6 years. Mean dialysis vintage was 51.0 34.0 months.Measurement of tumor marker concentration of hemodialysis patientsThe mean value of CA-153, CA125, and GOT fall in normal range (16.516.3 before hemodialysis, and 18.616.3 after hemodialysis, compared with 31.3 U/ml normal value, 35.238.9 before dialysis, and 34.341.2 after hemodialysis, compared to Correlates of serum markersCorrelations bet ween serum markers levels and age, duration of dialysis and Charlsons score are tested. Of all variables, patient age and Charlsons score are correlated with levels of some serum markers. CEA level was correlated with Charlsons score (r=0.42, p=0.03) (Fig. 1).GOT level was correlated with age (r=0.42, p=0.02) (Fig. 2) and Charlsons score (r=0.48, p=0.01) (Fig. 3). Other variables, including CA-153, CA125 is not correlated with age (r=0.07, p=0.7 r=0.2, p=0.3, respectively), and also not correlated with duration of HD, Charlsons score (Table 2).Direct effect of hemodialysis on concentration of serum markersSince the data of CA-153, CA125, CEA and GOT fail in normal distribution test, Wilcoson subscribe rank tested is chosen to compare groups before and after hemodialysis. Groups of CA-153, CA125, CEA, and GOT before hemodialysis are not significantly different to that after hemodialysis (Table 3).sermonCA-153, CA-125, CEA are commonly used tumor markers. CA-125 is a glycoprotein wit h high molecular weight ( 200 kDa), and is a cancer antigen for monitor mesothelium especially for ovarian cancer. Recently, CA-125 is used to monitor mesothelial cell viability in PD patients 9,10. CEA is carcinoembryonic antigen with a molecular weight about 180-200 kDa, commonly used for monitoring gastric cancer 11, weakly correlate with carotid atherosclerosis 12, and with prognostic value of colorectal cancer in PD patients 13. The mean value of CEA of 28 patients is higher than normal value, which is consistent with antecedent reports that patients with ESRD are usually with higher risk of cancer, and with higher levels of tumor markers 14. In our cases, patient no.2, 5, 9, 13 and 27 were expired within 1 year after diagnosis. Patient no. 2 is finally diagnosed as hepatoma, patient no. 5 is cirrhosis of liver and died in septicemia, patient no. 9 is died in leukemia, and patient no 13 is died in lung cancer. It shows that high levels of CEA correlated with Charlsons score wh ich implies poor outcome, however it remain further confirmation. CA-153 is correlated to risk of liver disease. Though 8% patients were diagnosed liver diseases, but their GOT value fall in normal range, and CA-153 values of them were also normal.There are many reports indicated that long term hemodialysis may affect levels of biomarkers. We showed that biomarkers alter non-significantly after one HD procedure. It is interesting that recent report indicated acute effects of HD treatment on up- or waste regulation of apoptotic genes in blood leucocytes 15 Tumor markers were produced by neoplastic cells, and can also be secreted by normal tissue. Many chronic diseases, e.g., inflammation, chronic bronchitis, cirrhosis of liver and renal diseases, affect the metabolism and elimination of tumor markers, may contribute the long term elevation of tumor markers. Our data show that abruptly term effect of HD on patients is not significant. And all 4 serum markers are not correlated with duration of HD. It seems that the response of patients to HD doesnt directly affect levels of these serum markers. However, CEA and GOT are shown to be candidates markers for monitoring HD outcome as they are positively correlated with Charlsons score.Table I Baseline demographic and clinical dataGFR, glomerular filtration rate NPCR, normalized protein catabolic rate, *Modified Charlsons comorbidity score is calculated according to Beddhu S, 2000.Table II. Correlation of serum markers and age, duration of HD, and Charlsons score.Table III. Comparison of serum tumor markers before and after hemodialysisLegends to FiguresFigure 1.Scatter plots, regression line, and 95% confidence intervals reflecting correlations between serum levels of CEA and Charlsons score of 28 HD patients.Figure 2.Scatter plots, regression line, and 95% confidence intervals reflecting correlations between serum levels of GOT and Charlsons score of 28 HD patients.Figure 3.Scatter plots, regression line, and 95% c onfidence intervals reflecting correlations between serum levels of GOT and age of 28 HD patients.