Inflammation in end‐stage renal disease: The hidden enemy (Review Article)

Abstract

Cardiovascular disease (CVD) remains the major cause of morbidity and mortality in end-stage renal disease (ESRD) patients. As traditional risk factors cannot alone explain the unacceptable high prevalence and incidence of CVD in this high-risk population, inflammation (interrelated to insulin resistance, oxidative stress, wasting and endothelial dysfunction) has been suggested to be a significant contributor. Indeed, several different inflammatory biomarkers, such as high sensitivity C-reactive protein (hs-CRP), have been shown to independently predict mortality in ESRD patients. As CRP is so strongly associated with vascular disease it has been suggested that this hepatic-derived protein is not only a marker, but also a mediator, of vascular disease. Although in vitro data from studies on endothelial cells, monocytes-macrophages and smooth muscle cells support a direct role for CRP in atherogenesis, data from studies performed in vivo have been controversial. The causes of the highly prevalent state of inflammation in ESRD are multiple, including inflammatory signals associated with the dialysis procedure, decreased renal function, volume overload, comorbidity and intercurrent clinical events. As the prevalence of inflammation varies considerably between continents and races, dietary and/or genetic factors may have an impact on inflammation in ESRD. Elevated CRP in dialysis patients could be evaluated at three different levels: (i) national/regional level; (ii) dialysis unit level; and (iii) individual patient level.

BMP-2 promotes phosphate uptake, phenotypic modulation, and calcification of human vascular smooth muscle cells

“…Thus, under inflammatory conditions, BMP-2 released from endothelial cells may act on adjacent SMC, induce osteochondrogenic differentiation and result in calcification in the arterial tree. Consistent with this notion, serum levels of TNF-α or other cytokines are associated with common complications such as vascular calcification in patients with ESRD [28] and elevated serum levels of BMP-2 have been found in uremic patients [29]. Thus, interruption of BMP-2 signal may be a potentially therapeutic target for intervention of vascular calcification.…”

Vasculoprotective Effects of Dietary Cocoa Flavanols in Patients on Hemodialysis

“…Elevated cardiac troponin levels reflect this and are an important predictor of all-cause mortality in ESRD (11). Nontraditional and interrelated risk factors that promote atherosclerosis include chronic inflammation and oxidative stress (12,13). Vascular dysfunctions ascribed to patients with ESRD are further perpetuated by impaired nitric oxide (NO) bioavailability.…”

NT-proBNP and Troponin T Levels Differ after Haemodialysis with a Low versus High Flux Membrane

“…Excessive water retention results in interdialytic weight gain (IDWG) that is a prominent risk factor for cardiovascular events (3). Other variables are malnutrition and inflammation that by themselves increase the risk for atherosclerosis (4). In general, the heart suffers from these alterations and moves into a progressive congestive heart failure and cardiomyopathy (5).…”