Assessment of inflammation and nutrition in patients with end-stage renal disease

Research output: Contribution to journalArticle

51 Scopus citations

Abstract

Malnutrition commonly occurs in patients with end-stage renal disease (ESRD), and hypoalbuminemia is considered the best clinical marker of malnutrition and mortality in this population. Recently, it has been recognized that a substantial number of patients with ESRD have serologic evidence of an augmented inflammatory response and moreover , inflammation may be as or more important than protein intake in causing hypoalbuminemia. In addition, the presence of inflammation may be a more powerful predictor of mortalilty than dietary protein intake. The presence of inflammation is often subtle and is detected by increased levels of the positive acute phase proteins, most notably C-reactive protein. The causes of the stimulation of the systemic inflammatory response may include reaction to dialyzer membranes, increased production of advanced glycosylated end-products, oxidative stress ot uremia and overt and occult infections, especially unrecognized arteriovenous graft infections. There is a complex relationship between inflammation and nutritional status. Inflammation can cause both anorexia with protein-calorie malnutrition as well as wasting through mechanisms mediated by cytokines. Novel therapies will need to be developed to counter this systemic inflammation since it appears to be a major cause of mortality in patients with end-stage renal disease.

Original languageEnglish (US)
Pages (from-to)249-259
Number of pages11
JournalJournal of Nephrology
Volume13
Issue number4
StatePublished - 2000

Keywords

  • Acute phase proteins
  • Advanced glycosylated end-products
  • Albumin
  • Arteriovenous graft infection
  • C-reactive protein
  • Cytokines
  • Oxidative stress

ASJC Scopus subject areas

  • Nephrology

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