Update on inflammation in chronic kidney disease

Oleh M. Akchurin, Frederick J. Kaskel

Research output: Contribution to journalArticle

119 Citations (Scopus)

Abstract

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).

Original languageEnglish (US)
Pages (from-to)84-92
Number of pages9
JournalBlood Purification
Volume39
Issue number1-3
DOIs
StatePublished - Jun 9 2015

Fingerprint

Chronic Renal Insufficiency
Inflammation
Dialysis
Dysbiosis
Mortality
Water Quality
Dialysis Solutions
Disease Management
Dietary Supplements
Acidosis
Glomerular Filtration Rate
Epigenomics
Population
Chronic Kidney Failure
Renal Dialysis
Adipose Tissue
Life Style
Oxidative Stress
Randomized Controlled Trials
Pharmacology

Keywords

  • Chronic kidney disease
  • Cytokines
  • Dialysis
  • End-stage renal disease
  • Inflammation
  • Malnutrition
  • Protein-energy wasting

ASJC Scopus subject areas

  • Nephrology
  • Hematology

Cite this

Update on inflammation in chronic kidney disease. / Akchurin, Oleh M.; Kaskel, Frederick J.

In: Blood Purification, Vol. 39, No. 1-3, 09.06.2015, p. 84-92.

Research output: Contribution to journalArticle

Akchurin, Oleh M. ; Kaskel, Frederick J. / Update on inflammation in chronic kidney disease. In: Blood Purification. 2015 ; Vol. 39, No. 1-3. pp. 84-92.
@article{6e734742daac4ad09849cc6a4e3b805f,
title = "Update on inflammation in chronic kidney disease",
abstract = "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).",
keywords = "Chronic kidney disease, Cytokines, Dialysis, End-stage renal disease, Inflammation, Malnutrition, Protein-energy wasting",
author = "Akchurin, {Oleh M.} and Kaskel, {Frederick J.}",
year = "2015",
month = "6",
day = "9",
doi = "10.1159/000368940",
language = "English (US)",
volume = "39",
pages = "84--92",
journal = "Blood Purification",
issn = "0253-5068",
publisher = "S. Karger AG",
number = "1-3",

}

TY - JOUR

T1 - Update on inflammation in chronic kidney disease

AU - Akchurin, Oleh M.

AU - Kaskel, Frederick J.

PY - 2015/6/9

Y1 - 2015/6/9

N2 - 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).

AB - 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).

KW - Chronic kidney disease

KW - Cytokines

KW - Dialysis

KW - End-stage renal disease

KW - Inflammation

KW - Malnutrition

KW - Protein-energy wasting

UR - http://www.scopus.com/inward/record.url?scp=84923104493&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84923104493&partnerID=8YFLogxK

U2 - 10.1159/000368940

DO - 10.1159/000368940

M3 - Article

C2 - 25662331

AN - SCOPUS:84923104493

VL - 39

SP - 84

EP - 92

JO - Blood Purification

JF - Blood Purification

SN - 0253-5068

IS - 1-3

ER -