Proceedings of the 18th ISBP Meeting

Inflammatory and Atherosclerotic Interactions in the Depleted Uremic Patient
Peter Stenvinkel

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

Address of Corresponding Author

Blood Purif 2001;19:53-61 (DOI: 10.1159/000014479)

  Key Words

• Malnutrition
• Inflammation
• Atherosclerosis
• Cytokines
• Soluble adhesion molecules

  Abstract

Despite the improvements in dialysis technology, the cardiovascular mortality rate is still unacceptably high among dialysis patients. It is obvious that traditional risk factors, such as hypertension, chronic heart failure (CHF), dyslipidemia and diabetes mellitus, may account for a large part of the increased cardiovascular mortality rate in these patients. However, based on recent research it could be speculated that other, non-traditional risk factors might also contribute to the high cardiovascular mortality rate in dialysis patients. Chronic inflammation, as evidenced by increased levels of pro-inflammatory cytokines and C-reactive protein (CRP), is a common feature in dialysis patients and is associated with an increased cardiovascular morbidity and mortality. Indeed, elevated levels of pro-inflammatory cytokines (such as TNF-, IL-1 and IL-6) may cause malnutrition and progressive atherosclerotic cardiovascular disease by several pathogenetic mechanisms, which will be discussed in this review. Based on the strong associations observed between malnutrition, inflammation and atherosclerosis in patients with chronic renal failure (CRF) we have proposed that these features constitute a specific syndrome (MIA), which carries a high mortality rate. As elevated levels of pro-inflammatory cytokines may play a central part in the vicious circle of malnutrition, inflammation and atherosclerosis, further research is needed to investigate whether or not different anti-cytokine treatment strategies may improve survival in dialysis patients.

Copyright © 2001 S. Karger AG, Basel

  Author Contacts

Peter Stenvinkel, MD
Division of Nephrology, Department of Medicine
University of California
Davis, CA 95616 (USA)
Fax +1 530 772 3791, E-Mail peter.stenvinkel@klinvet.ki.se

  Article Information

Number of Print Pages : 9
Number of Figures : 4, Number of Tables : 3, Number of References : 90