Aspects of Immune Dysfunction in End-stage Renal Disease

Kato, Shinichi; Chmielewski, Michael S.; Honda, Hirokazu; Pecoits‐Filho, Roberto; Matsuo, Seiichi; Yuzawa, Yukio; Tranæus, Anders; Stenvinkel, Peter; Lindholm, Bengt

doi:10.2215/cjn.00950208

Cited by 926 publications

(794 citation statements)

References 65 publications

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“…This does not, however, preclude a pathophysiologic role of endotoxemia in CKD as previously explained. Whatever the cause may be, higher plasma sCD14 is indicative of a persistent activation of monocytic cells, which may contribute to microinflammation in CKD and associated adverse outcomes (42).…”

Section: Discussionmentioning

confidence: 99%

Associations of Soluble CD14 and Endotoxin with Mortality, Cardiovascular Disease, and Progression of Kidney Disease among Patients with CKD

Poesen

Ramezani

Claes

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives CD14 plays a key role in the innate immunity as pattern-recognition receptor of endotoxin. Higher levels of soluble CD14 (sCD14) are associated with overall mortality in hemodialysis patients. The influence of kidney function on plasma sCD14 levels and its relationship with adverse outcomes in patients with CKD not yet on dialysis is unknown. This study examines the associations between plasma levels of sCD14 and endotoxin with adverse outcomes in patients with CKD.Design, setting, participants, & measurements We measured plasma levels of sCD14 and endotoxin in 495 Leuven Mild-to-Moderate CKD Study participants. Mild-to-moderate CKD was defined as presence of kidney damage or eGFR,60 ml/min per 1.73 m 2 for $3 months, with exclusion of patients on RRT. Study participants were enrolled between November 2005 and September 2006.Results Plasma sCD14 was negatively associated with eGFR (r=-0.34, P,0.001). During a median follow-up of 54 (interquartile range, 23-58) months, 53 patients died. Plasma sCD14 was predictive of mortality, even after adjustment for renal function, Framingham risk factors, markers of mineral bone metabolism, and nutritional and inflammatory parameters (hazard ratio [HR] per SD higher of 1.90; 95% confidence interval [95% CI],1.32 to 2.74; P,0.001). After adjustment for the same risk factors, plasma sCD14 was also a predictor of cardiovascular disease (HR, 1.30; 95% CI, 1.00 to 1.69; P=0.05). Although plasma sCD14 was associated with progression of CKD, defined as reaching ESRD or doubling of serum creatinine in models adjusted for CKD-specific risk factors (HR, 1.24; 95% CI, 1.01 to 1.52; P=0.04), significance was lost when adjusted for proteinuria (HR, 1.19; 95% CI, 0.96 to 1.48; P=0.11). There was neither correlation between plasma endotoxin and sCD14 (r=-0.06, P=0.20) nor was endotoxin independently associated with adverse outcome during follow-up.Conclusions Plasma sCD14 is elevated in patients with decreased kidney function and associated with mortality and cardiovascular disease in patients with CKD not yet on dialysis.

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Section: Discussionmentioning

confidence: 99%

Associations of Soluble CD14 and Endotoxin with Mortality, Cardiovascular Disease, and Progression of Kidney Disease among Patients with CKD

Poesen

Ramezani

Claes

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…Immune dysfunction among patients with renal insufficiency is well characterized, 8 and may influence risk of both renal and urothelial cancers. 9 Another important area of continued research following up on these findings is whether the relationship between CKD and RCC differs by race or ethnicity.…”

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confidence: 99%

CKD and Risk of Renal Cell Carcinoma

Hofmann

Purdue

2014

Journal of the American Society of Nephrology

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“…Decreased kidney function is associated with an immune dysfunction state that is known to contribute to the high prevalence of infections among these individuals (Kato et al, 2008). Thus, decreased kidney function may predispose to periodontitis, a chronic bacterial infection/overgrowth (Fisher, Taylor, West, & McCarthy, 2011).…”

Section: Discussionmentioning

confidence: 99%

Periodontitis and health‐related quality of life in hemodialysis patients

Iwasaki

Borgnakke

Awano

et al. 2016

Clinical & Exp Dental Res

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Periodontitis is common among dialysis patients. The current cross‐sectional study aimed to explore associations between periodontitis and health‐related quality of life (HRQoL) among hemodialysis patients. Data from 188 dentate patients undergoing hemodialysis between May and July 2008 at a medical center in Kitakyushu city, Japan, were analyzed while applying modified Centers for Disease Control and Prevention/American Academy of Periodontology periodontitis case definitions to categorize the participants into the following three groups: severe, moderate, and no/mild periodontitis, respectively. HRQoL was assessed by the Medical Outcomes Study 36‐Item Short Form Health Survey (SF‐36) where a higher score indicates better health status. Associations between periodontitis groups and the eight health domains of SF‐36 were evaluated using general linear models that were adjusted for age, sex, underlying cause of dialysis, duration of dialysis, comorbidities, serum biomarkers, body mass index, smoking status, and alcohol use. Among the 188 participants, 18 (9.6%) had severe periodontitis, 100 (53.2%) had moderate periodontitis, and the remaining 70 (37.2%) had no/mild periodontitis. Compared with the participants with no/mild periodontitis, those with severe periodontitis had worse scores in the following five of eight SF‐36 health scales: physical functioning, role physical, vitality, social functioning, and mental health (P < 0.05). The findings suggest an independent relationship between severe periodontitis and decreased HRQoL among dialysis patients.

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Aspects of Immune Dysfunction in End-stage Renal Disease

Cited by 926 publications

References 65 publications

Associations of Soluble CD14 and Endotoxin with Mortality, Cardiovascular Disease, and Progression of Kidney Disease among Patients with CKD

Associations of Soluble CD14 and Endotoxin with Mortality, Cardiovascular Disease, and Progression of Kidney Disease among Patients with CKD

CKD and Risk of Renal Cell Carcinoma

Periodontitis and health‐related quality of life in hemodialysis patients

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