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Update on inflammation in chronic kidney disease
Oleh M Akchurin1, Frederick Kaskel
1Weill Cornell College of Medicine, Department of Pediatrics, New York, N.Y., USA.
Insights
Chronic inflammation is a key factor in chronic kidney disease (CKD) and end-stage renal disease (ESRD), contributing to high mortality rates. Lifestyle changes and dietary supplements show promise in managing inflammation in CKD patients.
Area of Science:
- Nephrology
- Immunology
- Internal Medicine
Background:
- Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are associated with high morbidity and mortality.
- Persistent low-grade inflammation is a significant factor in CKD pathophysiology, contributing to cardiovascular events, mortality, and protein-energy wasting.
Purpose of the Study:
- To review the contributing factors to chronic inflammation in CKD.
- To discuss interventions targeting inflammation in CKD patients.
- To highlight the role of inflammation in dialysis patients.
Main Methods:
- Literature review of factors contributing to inflammation in CKD.
- Analysis of interventions for managing inflammation in CKD.
- Examination of the role of extracorporeal factors in dialysis-related inflammation.
Main Results:
- Multiple factors, including cytokine dysregulation, oxidative stress, infections, and gut dysbiosis, contribute to inflammation in CKD.
- Inflammation severity correlates with declining glomerular filtration rate (GFR).
- Dialysis patients experience additional inflammatory triggers from extracorporeal circuits and dialysate.
Conclusions:
- Chronic inflammation is a common comorbidity in CKD and dialysis patients.
- Interventions like physical activity modification and dietary supplementation are safe and effective.
- Further research is needed to assess intervention effects on hard outcomes and explore inflammation in specific CKD populations.
Background:
Despite recent advances in chronic kidney disease (CKD) and end-stage renal disease (ESRD) management, morbidity and mortality in this population remain exceptionally high. Persistent, low-grade inflammation has been recognized as an important component of CKD, playing a unique role in its pathophysiology and being accountable in part for cardiovascular and all-cause mortality, as well as contributing to the development of protein-energy wasting.
Summary:
The variety of factors contribute to chronic inflammatory status in CKD, including increased production and decreased clearance of pro-inflammatory cytokines, oxidative stress and acidosis, chronic and recurrent infections, including those related to dialysis access, altered metabolism of adipose tissue, and intestinal dysbiosis. Inflammation directly correlates with the glomerular filtration rate (GFR) in CKD and culminates in dialysis patients, where extracorporeal factors, such as impurities in dialysis water, microbiological quality of the dialysate, and bioincompatible factors in the dialysis circuit play an additional role. Genetic and epigenetic influences contributing to inflammatory activation in CKD are currently being intensively investigated. A number of interventions have been proposed to target inflammation in CKD, including lifestyle modifications, pharmacological agents, and optimization of dialysis. Importantly, some of these therapies have been recently tested in randomized controlled trials.
Key Messages:
Chronic inflammation should be regarded as a common comorbid condition in CKD and especially in dialysis patients. A number of interventions have been proven to be safe and effective in well-designed clinical studies. This includes such inexpensive approaches as modification of physical activity and dietary supplementation. Further investigations are needed to evaluate the effects of these interventions on hard outcomes, as well as to better understand the role of inflammation in selected CKD populations (e.g., in children).
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