Inflammatory and atherosclerotic interactions in the depleted uremic patient

被引:171
作者
Stenvinkel, P [1 ]
机构
[1] Univ Calif Davis, Dept Med, Div Nephrol, Davis, CA 95616 USA
关键词
malnutrition; inflammation; atherosclerosis; cytokines; soluble adhesion molecules;
D O I
10.1159/000014479
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Despite the improvements in dialysis technology, the cardiovascular mortality rate is still unacceptably high among dialysis patients. It is obvious that traditional risk factors, such as hypertension, chronic heart failure (CHF), dyslipidemia and diabetes mellitus, may account for a large part of the increased cardiovascular mortality rate in these patients. However, based on recent research it could be speculated that other, non-traditional risk factors might also contribute to the high cardiovascular mortality rate in dialysis patients. Chronic inflammation, as evidenced by increased levels of pro-inflammatory cytokines and C-reactive protein (CRP), is a common feature in dialysis patients and is associated with an increased cardiovascular morbidity and mortality. Indeed, elevated levels of pro-inflammatory cytokines (such as TNF-alpha, IL-1 and IL-6) may cause malnutrition and progressive atherosclerotic cardiovascular disease by several pathogenetic mechanisms, which will be discussed in this review. Based on the strong associations observed between malnutrition, inflammation and atherosclerosis in patients with chronic renal failure (CRF) we have proposed that these features constitute a specific syndrome (MIA), which carries a high mortality rate. As elevated levels of pro-inflammatory cytokines may play a central part in the vicious circle of malnutrition, inflammation and atherosclerosis, further research is needed to investigate whether or not different anti-cytokine treatment strategies may improve survival in dialysis patients. Copyright (C) 2001 S. Karger AG, Basel.
引用
收藏
页码:53 / 61
页数:9
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