Advances in End-Stage Renal Diseases 2001
International Conference on Dialysis III, January 18–19, 2001, Miami Beach, Fla.
Editors: Nathan W. Levin, New York, N.Y.; Claudio Ronco, Vicenza

Paper

Malnutrition and Chronic Inflammation as Risk Factors for Cardiovascular Disease in Chronic Renal Failure
Peter Stenvinkel

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

Address of Corresponding Author

Blood Purif 2001;19:143-151 (DOI: 10.1159/000046932)

  Abstract

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Despite the recent considerable improvements in dialysis technology, cardiovascular disease (CVD) still remains the main cause of morbidity and mortality in maintenance hemodialysis (HD) patients. It is obvious that ‘traditional’ risk factors, such as hypertension, chronic heart failure, dyslipidemia, tobacco smoking and diabetes mellitus, may account for a large part of the increased cardiovascular mortality rate observed in these patients. However, based on recent research it is evident that also other, ‘nontraditional’, risk factors, such as inflammation, oxidative stress and malnutrition, may contribute to an increased cardiovascular mortality among dialysis patients. Chronic inflammation, as evidenced by increased levels of various acute phase reactants such as C-reactive protein (CRP), fibrinogen, serum amyloid A (SAA), transferrin, serum albumin and prealbumin, is a common feature in dialysis patients. Various pro-inflammatory cytokines are the major mediators of acute phase protein induction and interleukin (IL)-6 is felt to be the principal cytokine influencing CRP changes. Although the association between inflammation and atherosclerotic CVD by now is well established, the mechanism(s) by which inflammation may accelerate atherosclerosis are not well understood. It has been proposed that various acute phase reactants promote atherogenesis by directly affecting different parts of the atherosclerotic process. On the other hand, recent evidence suggests that inflammation may rather be a marker of an atherogenic milieu and that the association is merely indirect. Indeed, inflammation has been proven to be associated with endothelial dysfunction, insulin resistance and oxidative stress, all of which may accelerate atherosclerosis.

Copyright © 2001 S. Karger AG, Basel

  Author Contacts

Peter Stenvinkel, MD
University of California Davis
Department of Internal Medicine, Division of Nephrology TB 136
Davis, CA 95616 (USA)
Fax +1 530 752 3791

  Article Information

Number of Print Pages : 9
Number of Figures : 2, Number of Tables : 4, Number of References : 85