Update on Inflammation in Chronic Kidney Disease

Abstract

Background: Despite recent advances in chronic kidney disease (CKD) and end-stage renal disease (ESRD) management, morbidity and mortality in this population remain exceptionally high. Persistent, low-grade inflammation has been recognized as an important component of CKD, playing a unique role in its pathophysiology and being accountable in part for cardiovascular and all-cause mortality, as well as contributing to the development of protein-energy wasting. Summary: The variety of factors contribute to chronic inflammatory status in CKD, including increased production and decreased clearance of pro-inflammatory cytokines, oxidative stress and acidosis, chronic and recurrent infections, including those related to dialysis access, altered metabolism of adipose tissue, and intestinal dysbiosis. Inflammation directly correlates with the glomerular filtration rate (GFR) in CKD and culminates in dialysis patients, where extracorporeal factors, such as impurities in dialysis water, microbiological quality of the dialysate, and bioincompatible factors in the dialysis circuit play an additional role. Genetic and epigenetic influences contributing to inflammatory activation in CKD are currently being intensively investigated. A number of interventions have been proposed to target inflammation in CKD, including lifestyle modifications, pharmacological agents, and optimization of dialysis. Importantly, some of these therapies have been recently tested in randomized controlled trials. Key Messages: Chronic inflammation should be regarded as a common comorbid condition in CKD and especially in dialysis patients. A number of interventions have been proven to be safe and effective in well-designed clinical studies. This includes such inexpensive approaches as modification of physical activity and dietary supplementation. Further investigations are needed to evaluate the effects of these interventions on hard outcomes, as well as to better understand the role of inflammation in selected CKD populations (e.g., in children).

Effect of kidney dysfunction on cerebral cortical thinning in elderly population

“…Yet another mechanism may contribute to the chronic inflammatory state that exists in patients with CKD 37 . It has been shown that inflammation could mediate the relationship between metabolic syndrome and cortical thinning 38 .…”

Systemic Inflammation and Seminal Parameters in Chronic Hemodialysis Patients

“…Systemic chronic inflammation (SCI) is a basic feature of chronic kidney disease (CKD)/end-stage renal disease (ESRD), especially in those undergoing hemodialysis (HD), and is related to genetics, uremia, dialysis, oxidative stress, and inflammatory factors (1). SCI is the result of the increased serum levels of proinflammatory cytokines such as interleukin (IL)-6 and tumor necrosis factor (TNF-α) as well as acute phase proteins such as C-reactive protein (CRP) and fibrinogen (1).…”

“…SCI is the result of the increased serum levels of proinflammatory cytokines such as interleukin (IL)-6 and tumor necrosis factor (TNF-α) as well as acute phase proteins such as C-reactive protein (CRP) and fibrinogen (1). It has now been well established that CKD/ESRD is a type of SCI (2).…”

Alteraciones en el eje intestino-riñón durante la enfermedad renal crónica: causas, consecuencias y propuestas de tratamiento

“…La inflamación crónica en la ERC ha sido relacionada con un mayor riesgo para las siguientes condiciones: eventos cardiovasculares, aterosclerosis temprana, desgaste proteicoenergético, alteraciones en el metabolismo mineral óseo y anemia resistente a eritropoyetina 14 .…”