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Nephrol Dial Transplant (2002) 17: 33-38
© 2002 European Renal Association-European Dialysis and Transplant Association


Inflammation in end-stage renal failure: could it be treated?

Peter Stenvinkel

Division of Nephrology, Department of Medicine, University of California, Davis, CA and Department of Veterans Affairs Medical Center, Mather, CA, USA

Abstract

End-stage renal disease (ESRD) is characterized by an exceptional mortality rate, much of which is the result of cardiovascular disease (CVD). Although traditional risk factors are common in ESRD patients, they may not be sufficient alone to account for the high prevalence of CVD in this condition. Recent evidence demonstrates that chronic inflammation, a non-traditional risk factor which is observed commonly in ESRD patients, may cause malnutrition and progressive atherosclerotic CVD by several pathogenetic mechanisms. The causes of inflammation in ESRD are multifactorial and, while it may reflect underlying CVD, an acute-phase reaction may also be a direct cause of vascular injury 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. Thus, it could be speculated that suppression of the vicious cycle of malnutrition, inflammation and atherosclerosis (MIA) would improve survival in dialysis patients. Recent evidence has demonstrated strong associations between inflammation and both increased oxidative stress and endothelial dysfunction in ESRD patients. As there is as yet no recognized, or even proposed, treatment for ESRD patients with chronic inflammation, it would be of obvious interest to study the long-term effect of various anti-inflammatory treatment strategies on the nutritional and cardiovascular status as well as the outcome in these patients.

Keywords: atherosclerosis; chronic renal failure; cytokine; inflammation; malnutrition

Notes

Correspondence and offprint requests to: Peter Stenvinkel, MD, Department of Renal Medicine K56, Huddinge University Hospital, 141 86 Huddinge, Sweden.


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