Subclinical inflammation in chronic renal fairule: markers, causes and cardiovascular mortality
Abstract
Patients with chronic renal failure on maintenance hemodialysis (HD) have a very high risk of total and cardiovascular mortality. Uremia is associated with systemic inflammation. This inflammation is related to the general and cardiovascular mortality of these patients. Elevation of C reactive protein (CRP), one of the most common inflammation markers is predictive of cardiovascular mortality in the dialysis population. Other inflammation markers that are predictive of adverse events in dialysis are interleukin -6 and Tumor necrosis factor alfa. Recently another inflammation marker, pentraxin 3 (PTX3) have shown to be a predictor of mortality, and in HD patients it has been related to cardiovascular disease
and calorie-protein malnutrition.
Several studies have shown that contaminations very small quantities of bacterial endotoxins produce a subclinical inflammatory response. In patients on HD there are several sources of endotoxin, as fluids, tissues and foreign bodies. Dialysis fluids are contaminated with Gram-negative bacteria and substances that can induce cytokine production derived from theses microorganisms. The presence of biofilms increases the risk of a
continuous contamination of these fluids. Severe periodontitis is associated with increased serum concentrations of high sensitivity-CRP and this is frequent in patients in HD and transplanted patients. Uremia per se can be a cause of endotoxin translocation from the intestine. Finally other sources of occult infection that can lead to a subclinical inflammatory response are the presence of catheters for dialysis, nonfunctioning grafts or fistulas and non-functioning kidney grafts.
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