[Chronic inflammation and cardiovascular risk in hemodialysis]

Cardiovascular disease (CVD) remains the main cause of morbidity and mortality in patients with end-stage renal disease (ESRD). Traditional risk factors are common in ESRD patients, but they alone may not be sufficient to account for the high prevalence of CVD in this population. Recent clinical evidence demonstrates that chronic inflammation, a non traditional risk factor which is commonly observed in ESRD patients, may be associated with the presence of poor nutritional parameters and progressive atherosclerotic CVD. Based on these observations, the presence in ESRD patients of a syndrome consisting in malnutrition, signs of systemic chronic inflammation and atherosclerosis (MIA syndrome) has recently been suggested. A central role in this syndrome is played by the proinflammatory cytokines generated in response to factors such as chronic renal failure and infectious-inflammatory co-morbid disease. It is now clear that the immune response, both innate and adaptive, is the main cause of inflammation characterising atherosclerosis. As there is as yet no recognized, or even proposed, treatment for ESRD patients with chronic inflammation, it would be of obvious interest to study the long-term effect of various inflammatory treatment strategies on the nutritional and cardiovascular status as well as the outcome in these patients.