Does inflammation affect outcomes in dialysis patients?
Does inflammation affect outcomes in dialysis patients?
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DOI：
10.1111/sdi.12686
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发表时间：
2018-07-01
影响因子：
1.6
通讯作者：
Chonchol, Michel
中科院分区：
文献类型：
--
作者：
Nowak, Kristen L.;Chonchol, Michel
慢性低度炎症是慢性肾病（CKD）的常见共病，尤其是在慢性透析患者中。在这篇综述中，我们考虑的问题是炎症是否会影响透析患者的预后。慢性透析患者的促炎细胞因子水平以及C反应蛋白水平升高。多种因素可能导致肾脏疾病患者的慢性炎症激活，包括尿毒症环境、生活方式和表观遗传影响、感染和血栓形成事件、透析过程和生态失调。CKD和慢性透析患者中炎性标志物增加与不良临床结局相关，包括全因死亡率、心血管事件、肾脏疾病进展、蛋白质能量消耗和运动功能减退、认知障碍以及其他不良后果，包括CKD-矿物质和骨骼疾病、贫血和胰岛素抵抗。已证明可减少CKD和慢性透析患者的慢性全身性炎症的策略包括药物和非药物干预。然而，尽管有证据表明，在采用各种策略治疗的肾病患者中，全身炎症标志物可以降低，但这改善临床结局的证据在很大程度上是不可用的，代表了未来重要的研究方向。总体而言，有强有力的观察证据表明，慢性透析患者的炎症水平较高，并且这与许多不良临床结局独立相关。靶向炎症是一种潜在的新颖和有吸引力的策略，如果它确实可以改善这一人群中常见的不良结局。
Chronic, low-grade inflammation is a common comorbid condition in chronic kidney disease (CKD), and particularly in chronic dialysis patients. In this review, we consider the question of whether inflammation affects outcomes in dialysis patients. Levels of proinflammatory cytokines, as well as C-reactive protein, are elevated in chronic dialysis patients. Multiple factors likely contribute to chronic inflammatory activation in kidney disease patients including the uremic milieu, lifestyle and epigenetic influences, infectious and thrombotic events, the dialysis process, and dysbiosis. Increased inflammatory markers in both CKD and chronic dialysis patients are associated with adverse clinical outcomes including all-cause mortality, cardiovascular events, kidney disease progression, protein energy wasting and diminished motor function, cognitive impairment, as well as other adverse consequences including CKD-mineral and bone disorder, anemia, and insulin resistance. Strategies that have been shown to reduce chronic systemic inflammation in CKD and chronic dialysis patients include both pharmacological and nonpharmacological interventions. However, despite evidence that systemic inflammatory markers can be lowered in kidney disease patients treated with various strategies, evidence that this improves clinical outcomes is largely unavailable and represents an important future research direction. Overall, there is strong observational evidence that inflammation is high in chronic dialysis patients and that this is independently associated with numerous adverse clinical outcomes. Targeting inflammation represents a potentially novel and attractive strategy if it can indeed improve adverse outcomes common in this population.