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Beta-glucans in advanced CKD: role in endotoxaemia and inflammation

Jonathan Wong1,2, Yonglong Zhang3, Oscar Swift4

  • 1Renal Research, East and North Herts NHS Trust, Coreys Mill Lane, Stevenage, SG1 4AB, UK. Jonathan.wong@nhs.net.

BMC Nephrology
|April 8, 2020
PubMed
Abstract

Insights

(1-3)-β-D glucans (BG) increase with declining kidney function, particularly in dialysis patients. High BG levels correlate with inflammation and can cause false positive endotoxin tests, suggesting altered gut permeability in renal impairment.

Area of Science:

  • Biochemistry
  • Clinical Chemistry
  • Immunology

Background:

  • (1-3)-β-D glucans (BG) are fungal cell wall components.
  • Elevated BG levels can indicate invasive fungal infection but may also occur in dialysis patients.
  • BG can interfere with endotoxin detection assays like the Limulus Amoebocyte Lysate (LAL) assay.

Purpose of the Study:

  • To investigate the relationship between BG levels, renal impairment, endotoxaemia, and inflammation.
  • To assess BG levels in patients with varying stages of chronic kidney disease (CKD) and on different dialysis modalities.
  • To determine the impact of BG on endotoxin detection and its association with inflammatory markers.

Main Methods:

  • Serum BG levels, inflammatory markers (CRP, TNFα, IL-6), and blood endotoxin were measured in controls and CKD patients (stages 1-5), including those on peritoneal dialysis (PD) and haemodialysis (HD).
  • Patients were studied before and after HD initiation.
  • LAL assays were performed with and without a BG blocking agent.

Main Results:

  • BG levels significantly increased with advancing CKD, peaking in HD patients (22% elevated).
  • BG levels correlated positively with inflammatory markers (CRP, TNFα, IL-6) and increased post-HD.
  • Endotoxin was detected in 10-53% of CKD patients, most in HD, correlating with BG; a BG blocking agent reduced detection to 5% in HD patients, indicating false positives.

Conclusions:

  • BG levels rise with decreasing renal function, are highest in dialysis patients, and correlate with inflammation.
  • High BG levels are linked to false-positive endotoxin detection, suggesting potential gut permeability issues in renal impairment.
  • The findings highlight the need to consider BG interference in endotoxin assays for patients with kidney disease and inflammation.
Keywords:
(1–3)-β-D glucanDialysisEndotoxinInflammation

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