Inflammatory Syndrome in Patients on Hemodialysis

Jofre, R.; Rodríguez-Benítez, Patrocinio; López‐Gómez, Juan M.; Pérez‐García, Rafael

doi:10.1681/asn.2006080926

Cited by 205 publications

(188 citation statements)

References 75 publications

(45 reference statements)

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“…83 Between 30 and 50% of CKD patients have elevated serum levels of inflammatory markers such as C-reactive protein, fibrinogen, interleukin-6, tumor necrosis factor-␣, factor VIIc, factor VIIIc, plasmin-antiplasmin complex, D-dimer, and the adhesion molecules E-selectin, VCAM-1 and ICAM-1. 84,85 Mechanisms are unclear but increased inflammatory mediators have been attributed to increased oxidative stress, accumulation of postsynthetically modified proteins, advanced glycation end products, and other agents normally cleared by the kidney. Thus, causes of inflammation may include comorbidities, oxidative stress, infections, and hemodialysis-related factors that depend on membrane biocompatibility and the dialysate.…”

Section: Dyslipidemia Inflammation and Oxidative Stress In Renal DImentioning

confidence: 99%

Chronic Kidney Disease

2007

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Abstract-Accelerated cardiovascular disease is a frequent complication of renal disease. Chronic kidney disease promotes hypertension and dyslipidemia, which in turn can contribute to the progression of renal failure. Furthermore, diabetic nephropathy is the leading cause of renal failure in developed countries. Together, hypertension, dyslipidemia, and diabetes are major risk factors for the development of endothelial dysfunction and progression of atherosclerosis. Inflammatory mediators are often elevated and the renin-angiotensin system is frequently activated in chronic kidney disease, which likely contributes through enhanced production of reactive oxygen species to the accelerated atherosclerosis observed in chronic kidney disease. Promoters of calcification are increased and inhibitors of calcification are reduced, which favors metastatic vascular calcification, an important participant in vascular injury associated with end-stage renal disease. Accelerated atherosclerosis will then lead to increased prevalence of coronary artery disease, heart failure, stroke, and peripheral arterial disease. Consequently, subjects with chronic renal failure are exposed to increased morbidity and mortality as a result of cardiovascular events. Prevention and treatment of cardiovascular disease are major considerations in the management of individuals with chronic kidney disease. Key Words: atherosclerosis Ⅲ hypertension Ⅲ kidney Ⅲ vasculature I t is increasingly apparent that individuals with chronic kidney disease (CKD) are more likely to die of cardiovascular (CV) disease (CVD) than to develop kidney failure. 1,2 A large cohort study comprising Ͼ130 000 elderly subjects showed that increased incidence of CV events could be in part related to the fact that persons with renal insufficiency are less likely to receive appropriate cardioprotective treatments. 3 However, beyond the effects of lack of appropriate therapy, it is clear that accelerated CVD is prevalent in subjects with CKD. The first part of the present review will therefore focus on the epidemiological links between impairment of renal function and adverse CV events, between albuminuria and CV events, and between serum cystatin C and CVD. The second part of the present review will address the mechanisms that lead to the association of renal and CVD, which include hypertension, dyslipidemia, activation of the renin-angiotensin system, endothelial dysfunction and the role of asymmetric dimethyl arginine (ADMA), oxidative stress, and inflammation. Finally, mechanisms that are involved in vascular calcification often found in CKD and end-stage renal disease (ESRD) will be described. Additionally, ESRD is associated with several specific complications caused by the uremic state per se, which can contribute to the development and progression of CVD through volume overload with consequent hypertension, anemia, uremic pericarditis, and cardiomyopathy. However, these issues will not be addressed because the emphasis will be on CKD before ESRD is reached. In addition, t...

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Section: Dyslipidemia Inflammation and Oxidative Stress In Renal DImentioning

confidence: 99%

Chronic Kidney Disease

2007

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“…These factors include the uremic milieu, infection, oxidative stress, co-morbidities, obesity, genetic or immunologic factors, exposure to dialyzer membrane and dialysate in those on dialysis. 6 The levels of inflammatory markers like fibrinogen, homocysteine, CRP are high in CKD patients with coronary heart disease (CHD).…”

Section: Introductionmentioning

confidence: 99%

Serum C-reactive protein levels in pre-dialysis chronic kidney disease patients in southern Nigeria

Adejumo¹,

Okaka²,

Okwuonu³

et al. 2016

Ghana Medical Journal

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SUMMARYBackground: Cardiovascular disease is the major cause of hospitalization and mortality in chronic kidney disease (CKD). C-reactive protein (CRP) is a marker of cardiovascular disease and predictor of mortality in CKD patients. CKD patients with elevated CRP should be identified early with institution of measures to treat cardiovascular risk factors in order to reduce attendant mortality. Aims: Determination of serum CRP levels in CKD patients and associated factors. Methods: This was a case-control study involving 80 consecutive CKD patients and 40 control subjects without CKD. Data obtained from participants included demographics, body mass index (BMI), and aetiology of CKD. Serum CRP levels, albumin, creatinine and lipid profile were determined. Cases and controls were compared. P values <0.05 were taken as significant Results: The mean age of the CKD subjects was 49.09±16.85 years. The median CRP value was significantly higher in the CKD group compared to controls (p=<0.001). Low, average and high cardiovascular event risk according to CRP values were present in 51(63.8%), 13(16.2%) and 16(20%) of the CKD patients respectively. Cardiovascular event risk was significantly higher in CKD subjects (p=<0.001). Serum creatinine, BMI, triglyceride and atherogenic index of plasma correlated positively with CRP. Estimated glomerular filtration rate (eGFR), high density lipoprotein-cholesterol and albumin correlated negatively with CRP. Elevated serum CRP was significantly predicted by low eGFR and high BMI on multivariate analysis. Conclusion: Chronic kidney disease patients have increased cardiovascular event risk. Interventions aimed at reducing weight and treating dyslipidaemia should be instituted early in order to reduce this risk.

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“…This calcification causes arterial wall stiffening and subsequently left ventricular hypertrophy (4,16). Moreover, endothelial dysfunction appears to be associated with high serum levels of inflammatory markers, such as C-reactive protein, interleukin (IL)-6, IL-1β, tumor necrosis factor (TNF)-α, and fibrinogen in patients with CKD (17). Under these conditions, levels of cell adhesion molecules, such as monocyte chemotactic protein (MCP)-1 and vascular cell adhesion molecule (VCAM)-1 are up-regulated in order to promote monocyte infiltration into the activated endothelium (18).…”

Section: Effects Of Urea On Endothelial Functionsmentioning

confidence: 99%