Novel approaches in an integrated therapy of inflammatory-associated wasting in end-stage renal disease

被引:44
作者
Stenvinkel, P
Lindholm, B
Heimbürger, O
机构
[1] Karolinska Univ Hosp, Div Renal Med, Karolinska Inst, Dept Clin Sci, S-14186 Huddinge, Sweden
[2] Baxter Novum, Huddinge, Sweden
关键词
D O I
10.1111/j.0894-0959.2004.17611.x
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
It is increasingly apparent that end-stage renal disease (ESRD) patients carry an inflammatory burden, which may play a pivotal role in the evolution of not only wasting, but also the massive increase in the relative risk of cardiovascular disease (CVD). Thus wasting is strongly associated with a persistent systemic inflammatory response, CVD, and impaired patient survival in end-stage renal disease (ESRD), as well as in other chronic diseases. Evidence suggests that a facilitative interaction between inflammatory cytokines and other factors such as poor appetite, comorbidity, acidosis, anemia, and hormonal derangements may cause wasting in this patient group. Clearly, isolated interventions in the form of nutritional energy and protein supplementation have seldom proven to be very effective in improving nutritional status and outcome in ESRD patients, presumably because of the need to attack other causative factors. Therefore, new treatment strategies must be evaluated. Strategies such as multiple appetite stimulants, various "anti-inflammatory diets," and new potentially useful anti-inflammatory pharmacologic agents may be tested alone, or in combination, to evaluate if these new therapeutic modalities can improve the outcome of ESRD patients. As the etiology of wasting in ESRD is multifactorial, we propose that its treatment must include not one, but a number of concomitant measures to provide an integrated therapy against this devastating complication.
引用
收藏
页码:505 / 515
页数:11
相关论文
共 140 条
[11]   Malnutrition and atherosclerosis in dialysis patients [J].
Beddhu, S ;
Pappas, LM ;
Ramkumar, N ;
Samore, MH .
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2004, 15 (03) :733-742
[12]   Association of serum albumin and atherosclerosis in chronic hemodialysis patients [J].
Beddhu, S ;
Kaysen, GA ;
Yan, GF ;
Sarnak, M ;
Agodoa, L ;
Ornt, D ;
Cheung, AK .
AMERICAN JOURNAL OF KIDNEY DISEASES, 2002, 40 (04) :721-727
[13]   Malnutrition, cardiac disease, and mortality:: An integrated point of view [J].
Bergström, J ;
Lindholm, B .
AMERICAN JOURNAL OF KIDNEY DISEASES, 1998, 32 (05) :834-841
[14]   Secondary prevention with antioxidants of cardiovascular disease in endstage renal disease (SPACE): randomised placebo-controlled trial [J].
Boaz, M ;
Smetana, S ;
Weinstein, T ;
Matas, Z ;
Gafter, U ;
Iaina, A ;
Knecht, A ;
Weissgarten, Y ;
Brunner, D ;
Fainaru, M ;
Green, MS .
LANCET, 2000, 356 (9237) :1213-1218
[15]  
Boccanfuso J A, 2000, J Ren Nutr, V10, P36, DOI 10.1016/S1051-2276(00)90021-9
[16]   Interleukin-6 predicts hypoalbuminemia, hypocholesterolemia, and mortality in hemodialysis patients [J].
Bologa, RM ;
Levine, DM ;
Parker, TS ;
Cheigh, JS ;
Serur, D ;
Stenzel, KH ;
Rubin, AL .
AMERICAN JOURNAL OF KIDNEY DISEASES, 1998, 32 (01) :107-114
[17]  
Bonafè M, 2001, EUR J IMMUNOL, V31, P2357, DOI 10.1002/1521-4141(200108)31:8<2357::AID-IMMU2357>3.3.CO
[18]  
2-O
[19]   Impact of angiotensin converting enzyme inhibition on post-coronary artery bypass interleukin 6 release [J].
Brull, DJ ;
Sanders, J ;
Rumley, A ;
Lowe, GD ;
Humphries, SE ;
Montgomery, HE .
HEART, 2002, 87 (03) :252-255
[20]   EFFECT OF INTRADIALYTIC PARENTERAL-NUTRITION ON MORTALITY-RATES IN END-STAGE RENAL-DISEASE CARE [J].
CAPELLI, JP ;
KUSHNER, H ;
CAMISCIOLI, TC ;
CHEN, SM ;
TORRES, MA .
AMERICAN JOURNAL OF KIDNEY DISEASES, 1994, 23 (06) :808-816