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MINERVA UROLOGICA E NEFROLOGICA

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Minerva Urologica e Nefrologica 2004 September;56(3):237-48

language: English

Systemic inflammation in dialysis patients with end-stage renal disease: causes and consequences

Yao Q., Axelsson J., Heimburger O., Stenvinkel P., Lindholm B.

Division of Baxter Novum and Renal Medicine Department of Clinical Science Karolinska Institutet, Stockholm, Sweden


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Despite rap­id im­prove­ments in di­al­y­sis tech­nol­o­gy dur­ing the ­last 20 ­years, the mor­tal­ity ­rate in end-­stage re­nal dis­ease (­ESRD) pa­tients treat­ed with di­al­y­sis is ­still un­ac­cept­ably ­high and com­par­able to ­that of ­many can­cer pa­tients ­with me­tas­ta­ses. The ­main ­cause of the in­creased mor­tal­ity in ­ESRD pa­tients is car­di­o­vas­cu­lar dis­ease (CVD), ­which is ­twice as com­mon and ad­vanc­es at ­twice the ­rate al­ready in pa­tients ­with ear­li­er stag­es of chron­ic kid­ney dis­ease as com­pared to the gen­er­al pop­u­la­tion. Although tra­di­tion­al ­risk fac­tors are com­mon in di­al­y­sis pa­tients, ­they can on­ly in ­part ex­plain the ­very ­high prev­a­lence of CVD in ­this pa­tient ­group. Recent ev­i­dence dem­on­strates ­that chron­ic in­flam­ma­tion, a non-tra­di­tion­al ­risk fac­tor ­which is a com­mon­ly ob­served in di­al­y­sis pa­tients, may ­cause mal­nu­tri­tion and pro­gres­sive ath­e­ros­cle­rot­ic CVD by sev­er­al pa­thog­e­net­ic mech­a­nisms. Available ­data sug­gest ­that pro-in­flam­ma­to­ry cy­to­kines ­play a cen­tral ­role in the gen­e­sis of ­both mal­nu­tri­tion and CVD in ­ESRD. While the ­long-­term ef­fects of chron­ic in­flam­ma­tion may be ­most im­por­tant in the path­o­gen­e­sis of CVD, the ­acute-­phase re­ac­tion may al­so be a di­rect ­cause of ­acute vas­cu­lar in­ju­ry by sev­er­al pa­thog­e­net­ic mech­a­nisms. The ­cause(s) of in­flam­ma­tion in di­al­y­sis are mul­ti­fac­to­ri­al and in­clude ­both di­al­y­sis-re­lat­ed and un­re­lat­ed fac­tors. Thus, it ­could be spec­u­lat­ed ­that sup­pres­sion of the vi­cious cy­cle of mal­nu­tri­tion, in­flam­ma­tion, and ath­ero­scler­o­sis (MIA syn­drome) ­would im­prove sur­vi­val in di­al­y­sis pa­tients. As ­there are cur­rent­ly no es­tab­lished guide­lines for the treat­ment of chron­ic in­flam­ma­tion in ­ESRD pa­tients, stud­ies on the ­long-­term ef­fects of var­i­ous ­anti-in­flam­ma­to­ry treat­ment strat­e­gies on the nu­tri­tion­al and car­di­o­vas­cu­lar stat­us as ­well as out­come in ­this pa­tient ­group are war­rant­ed.

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