Chronic inflammation in end-stage renal disease and dialysis

Abstract

Under normal conditions, inflammation is a protective and physiological response to various harmful stimuli. However, in several chronic debilitating disorders, such as chronic kidney disease, inflammation becomes maladaptive, uncontrolled and persistent. Systemic persistent inflammation has, for almost 20 years, been recognized as a major contributor to the uraemic phenotype (such as cardiovascular disease, protein energy wasting, depression, osteoporosis and frailty), and a predictor of cardiovascular and total mortality. Since inflammation is mechanistically related to several ageing processes (inflammageing), it may be a major driver of a progeric phenotype in the uraemic milieu. Inflammation is likely the consequence of a multifactorial aetiology and interacts with a number of factors that emerge when uraemic toxins accumulate. Beside interventions aiming to decrease the production of inflammatory molecules in the uraemic milieu, novel strategies to increase the removal of large middle molecules, such as expanded haemodialysis, may be an opportunity to decrease the inflammatory allostatic load associated with retention of middle molecular weight uraemic toxins.

Von Willebrand factor as a thrombotic and inflammatory mediator in critical illness

“…A study that evaluated dogs presenting with AKI showed that the ratio of vWF antigen to collagen binding activity was increased, while collagen‐activated platelet aggregation was decreased in AKI when compared to healthy controls . These data are increasingly interesting in light of the evaluation of vWF in patients with chronic renal disease, another physiological state characterized by systemic inflammation . In a consistent pattern with the Kornblith study on TBI, patients with uremia demonstrated both elevated vWF levels and a decreased ratio of ristocetin cofactor activity to vWF antigen.…”

Inflammation and Premature Ageing in Chronic Kidney Disease

“…At progressively increasing concentration, these substances exert toxic effects, which eventually become apparent as symptoms of uremia. The altering effects of the uremic milieu on the immune system has been described as uremic inflammation [10,11], and include mechanisms of both immunoactivation and immunosuppression. Uremic inflammation resembles the premature ageing phenotype in many ways.…”

Decreased Bioimpedance Phase Angle in Patients with Diabetic Chronic Kidney Disease Stage 5

“…Therefore, our results suggest that it may be necessary to use a combination of the PhA and hs-CRP levels when testing models that predict sarcopenia, frailty, and/or mortality. Chronic inflammatory conditions, which are common in patients with DMCKD, have been recognized as a major contributor to cardiovascular disease, protein energy wasting, osteoporosis, sarcopenia, and frailty [25][26][27].…”