Background: Patient-reported symptoms are associated with inflammatory biomarkers in many chronic diseases. This secondary analysis of Technology Assisted stepped Collaborative Care (TĀCcare) trial data examined associations of inflammatory biomarkers with pain, fatigue, and depression in patients with ESKD and the effects of the TĀCcare intervention versus health education control on these biomarkers.
Methods: Patients completed questionnaires and provided blood samples at baseline, 3, and 6 months. Interleukin (IL-)1RA, IL-10, tumor necrosis factor (TNF)-α, high sensitivity C-reactive protein (hs-CRP), and IL-6 were measured. IL-6/IL-10 ratios were calculated to examine T helper cells type 1 to type 2 (Th1/Th2) balance. Linear mixed-effects modeling was used to examine within- and between-group differences over the course of 3 and 6 months after adjusting for age, gender, race, and comorbidities.
Results: Among the 160 patients (mean age 58±14, 55% men, 52% white), there were no significant associations between inflammatory biomarker levels and depression, pain, or fatigue at baseline. Both groups demonstrated significant reductions in anti-inflammatory cytokines (IL-10 and IL-1RA) over the study period (p<0.05). Compared to baseline, the treatment group had significant decreases in the inflammatory marker, TNF-α (p<0.001) at 3-months, whereas the control group had a significant increase in the inflammatory marker IL-6/IL-10 ratio (p=0.02). Additionally, at 6-months the control group had a significant increase in IL-6/IL-10 ratio (β=0.75, p<0.001) and decreases in IL-2 and TNF-α (p<0.05). For the between-group analyses, the treatment group had significantly decreased IL-2 (β=-0.53, p<0.001) compared to the control at 3 months. No other within- or between-group comparisons were significant.
Conclusions: There were no associations between biomarkers and patient-reported symptoms in a large ESKD cohort. As compared to control, TĀCcare intervention had a short term impact on reducing inflammatory burden. More studies are needed to determine if collaborative care interventions have the potential to attenuate inflammatory burden and immune imbalances in patients with ESKD.