Helicobacter pylori Eradication Improves the Malnutrition, Inflammation and Atherosclerosis Syndrome in Peritoneal Dialysis Patients

Background. Helicobacter pylori (Hp) infection has frequently been detected in dialysis patients. Chronic infection induces cytokine production which is poorly cleared by inefficient kidneys. These cytokines have systemic and catabolic effects. We studied the effects of Hp infection-eradication on serum cytokine levels, nutrition and endothelial function (EF) markers in peritoneal dialysis (PD) patients. Methods. Hp-infection was diagnosed by breath test. Prior and post eradication we measured, nutritional markers: biochemical, daily food-intake and appetite modulator (orexigen neuropeptide-Y, NPY, anorexigen cholecystokinin, CCK). Stomach acid secretion: pepsinogen-I and II, and inflammatory markers: C-reactive protein (CRP), plasma TNF-α and IL-6. And EF markers which were taken pre- and post-venous occlusion test (VOT) in the right-arm for 10 min: tissue-type plasminogen activator (tPA), NO3 (representing nitric oxide) and plasminogen activator inhibitor (PAI). Forty-eight clinically stable PD patients divided into four groups according to Hp- infection and food intake werestudied: I, Hp(+) and low food-intake (<30 kcal/kg/day, DOQI-guidelines), n=12; II, Hp(+) and normal food intake,n=4, III Hp(-) and low food intake, n=5, IV, Hp(-) and normal food intake, n=27. Group-I showed the highest cytokines and the lowest residual renal function (RRF). TNF-α: group-I 127±85.5*pg/ml; group-II 70.5±25; group-III 60.5±10* and group-IV 43.4±5.4*, *p<0.05. IL-6: group-I 34.2±18* pg/ml,group-II 3.4±7*, *p<0.05, group-III 11.1±7.9*, *p<0.05 and group-IV 1.02±0.65*, *p<0.05. RRF was significantlyhigher in group-IV (4.8±1.6 ml/min*) than group-I (2.7±2.3*, *p<0.05). After Hp-eradication in group-I, nutritionalmarkers and NPY increased. Inflammatory, gastric acid-secretion parameters decreased. EF markers also improved.Control group included 10 volunteers, non-renal subjects infected by Hp who followed similar process, includingeradication treatment. Hp-eradication was associated to improvement in inflammatory and stomach acid-secretionmarkers