Inflammation, nutritional status, PUFA profile and outcome in hemodialysis patients

Patients with end-stage renal disease (ESRD) include a significant percentage of malnourished patients with other risk factors: dyslipoproteinemia, insulin resistance, increased oxidative stress and inflammation that together impair endothelial function. Abnormal polyunsaturated fatty acids (PUFA) patterns are reported in patients with ESRD. The basic mechanisms of these disorders are connected with changes in cell functions at the membrane level. Vascular smooth muscle cell proliferation plays an important role in the pathogenesis of atherosclerosis. We have examined the association between atherosclerotic risk factors and nutritional status in hemodialysis (HD) patients. Mortality was followed for up to 18 month. Forty-three HD patients were examined (20 males, 23 females, ages 55?12 years). Nutritional and inflammatory markers, including serum concentrations of C-reactive protein (CRP), tumor necrosis factor alpha (TNF-alpha), and interleukin 6 (IL-6), were measured. There was significant positive correlation between the plasma albumin level and CRP. Significant correlation was found between plasma the cholesterol level and some PUFA. Increasing inflammation and endothelial dysfunction predict the development of vascular disease. We report on the relationship between inflammatory markers and nutritional parameter, indices of atherosclerosis and other cardiovascular risk factors in patients on hemodialysis.

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Effect of Clarithromycin on Inflammatory Markers in Patients with Atherosclerosis

Clinical and Diagnostic Laboratory Immunology ◽

10.1128/cdli.10.4.525-528.2003 ◽

2003 ◽

Vol 10 (4) ◽

pp. 525-528 ◽

Cited By ~ 8

Author(s):

Hans F. Berg ◽

Boulos Maraha ◽

Gert-Jan Scheffer ◽

Marcel F. Peeters ◽

Jan A. J. W. Kluytmans

Keyword(s):

Inflammatory Markers ◽

Interleukin 2 ◽

Patient Characteristics ◽

Double Blind Study ◽

Double Blind ◽

Necrosis Factor Alpha ◽

Treatment Groups ◽

Reactive Protein ◽

Factor Alpha ◽

Artery Disease

ABSTRACT Atherosclerosis can to a certain extent be regarded as an inflammatory disease. Also, inflammatory markers may provide information about cardiovascular risk. Whether macrolide antibiotics, especially clarithromycin, have an anti-inflammatory effect in patients with atherosclerosis is not exactly known. To study this phenomenon, a placebo-controlled, randomized, double-blind study was performed. A total of 231 patients with documented coronary artery disease received a daily dose of either 500 mg of slow-release clarithromycin or placebo until the day of surgery. Levels of inflammatory markers (C-reactive protein, interleukin-2 receptor [IL-2R], IL-6, IL-8, and tumor necrosis factor alpha) were assessed during the preoperative outpatient visit, on the day of surgery, and 8 weeks after surgery. Also, changes in the levels of inflammatory markers between visits were determined by delta calculations. Baseline patient characteristics were balanced between the two treatment groups: the average age was 66 years (standard deviation [SD] = 9.0), 79% of the patients were male, and the average number of tablets used was 16 (SD = 9.3). The inflammatory markers of the groups as well as the delta calculations were not significantly changed. Treatment with clarithromycin did not influence the inflammatory markers in patients with atherosclerosis.

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Diet-induced prediabetes: effects of exercise treatment on risk factors for cardiovascular complications

Nutrition & Metabolism ◽

10.1186/s12986-021-00573-0 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Mluleki Luvuno ◽

Andile Khathi ◽

Musa V. Mabandla

Keyword(s):

Risk Factors ◽

Animal Model ◽

Caloric Intake ◽

Cardiovascular Complications ◽

Necrosis Factor Alpha ◽

Reactive Protein ◽

Factor Alpha ◽

Oxide Synthase ◽

Endothelial Nitric Oxide ◽

Necrosis Factor

Abstract Background An animal model of prediabetes that has been developed in our laboratory using a high fat high carbohydrate diet and lack of physical activity displays risk factors for cardiovascular complications. The effect of exercise against these risk factors in this animal model remains unknown. Therefore, we evaluated the effect of intermittent and regular exercise treatment on the risk factors for cardiovascular complications in this animal model of prediabetes. Methods Following prediabetes induction, animals were randomly assigned to the following groups (n = 6): non-diabetic, prediabetic, intermittently exercising prediabetic and regularly exercising prediabetic. Exercise exposure was 7 weeks long. Body weight changes, caloric intake, blood glucose, total cholesterol, and triglyceride concentration was measured after 20 and 29 weeks while blood pressure was only measured after 29 weeks. Plasma endothelial nitric oxide synthase, malonaldehyde, glutathione peroxidase, tumour necrosis factor-alpha and C-reactive protein concentration from the heart were measured 2 weeks post-exercise termination (week 30). Results We found increased body weight, caloric intake and mean arterial pressure in the prediabetic group by comparison to the non-prediabetic group. The same trend was observed in blood glucose and triglyceride concentrations. However, all of these parameters were reduced in the intermittently exercising prediabetic and regularly exercising prediabetic groups. This reduction was further accompanied by a decrease in the endothelial nitric oxide synthase, tumour necrosis factor-alpha and C-reactive protein concentration with improved oxidative stress biomarkers. Conclusions The progression of pre-diabetes to diabetes is slowed or possibly stopped by exercise (regular or intermittent). Additionally, biomarker profiles indicative of cardiovascular disease in pre-diabetics are improved by exercise.

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POOR NUTRITIONAL STATUS AND INFLAMMATION: C-Reactive Protein and End-Stage Renal Disease

Seminars in Dialysis ◽

10.1111/j.0894-0959.2004.17604.x ◽

2004 ◽

Vol 17 (6) ◽

pp. 438-448 ◽

Cited By ~ 42

Author(s):

Eduardo Lacson ◽

Nathan W. Levin

Keyword(s):

Nutritional Status ◽

Renal Disease ◽

End Stage Renal Disease ◽

C Reactive Protein ◽

Reactive Protein ◽

Poor Nutritional Status ◽

Stage Renal Disease ◽

End Stage

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Hemodialysis Membranes: Interleukins, Biocompatibility, and Middle Molecules

Journal of the American Society of Nephrology ◽

10.1681/asn.v13suppl_1s62 ◽

2002 ◽

Vol 13 (suppl 1) ◽

pp. S62-S71

Author(s):

Walter H. Hörl

Keyword(s):

End Stage Renal Disease ◽

Hemodialysis Patients ◽

Maintenance Hemodialysis ◽

Necrosis Factor Alpha ◽

Middle Molecules ◽

End Products ◽

Factor Alpha ◽

Stage Renal Disease ◽

End Stage ◽

Necrosis Factor

ABSTRACT. Maintenance hemodialysis patients display evidence of elevated interleukin-1 (IL-1) and tumor necrosis factor alpha release after stimulation either by contaminated dialysate, bioincompatible membrane material, or both. This release is followed by the stimulated secretion of a large number of other interleukins, particularly IL-6, the cytokine principally responsible for acute-phase protein synthesis. It has been shown that high levels of the circulating proinflammatory cytokines IL-1, tumor necrosis factor alpha, IL-6, and IL-13 are associated with mortality in hemodialysis patients. Essential functions of polymorphonuclear leukocytes—that is, phagocytosis, oxygen species production, upregulation of specific cell surface receptor proteins, or apoptosis—are disturbed in patients with end-stage renal disease. These are further altered as a result of complement activation by the hemodialysis procedure, particularly if bioincompatible dialyzers are used. Polymorphonuclear leukocyte degranulation occurring during extracorporeal circulation does not depend on complement activation but rather on intracellular calcium and the presence or absence of the degranulation inhibitory proteins angiogenin and complement factor D. Clinical signs and symptoms of end-stage renal disease patients are at least in part related to the accumulation of middle molecules such as β2-microglobulin, parathyroid hormone, advanced glycation end products, advanced lipoxidation end products, advanced oxidation protein products (formed as a result of oxidative stress, carbonyl stress, or both), granulocyte inhibitory proteins, or leptin. Currently available membrane materials do not provide long-lasting, effective reduction of middle molecules in patients who require maintenance hemodialysis.

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P1582Prognostic value of C-reactive protein/albumin ratio for cardiovascular morbidity and mortality in end-stage renal disease patients with incident haemodialysis therapy

European Heart Journal ◽

10.1093/eurheartj/ehz748.0342 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

H Takahashi ◽

H Ishii ◽

Y Kumada ◽

T Oshima ◽

T Sakakibara ◽

...

Keyword(s):

Risk Factors ◽

End Stage Renal Disease ◽

Survival Rates ◽

Morbidity And Mortality ◽

C Reactive Protein ◽

Albumin Ratio ◽

Reactive Protein ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Abstract Background Hypoalbuminemia, a manifestation of protein-energy wasting or malnutrition, is commonly observed in patients with end-stage renal disease (ESRD), and is associated with chronic inflammation and increasing cardiovascular (CV) risk. Recently, C-reactive protein (CRP)/albumin ratio at discharge is reportedly a well-predictor of mortality in severe sepsis or cancer patients. We investigated prognostic value of the CRP/albumin ratio at just starting haemodialysis (HD) therapy for CV morbidity and mortality in patients with ESRD. Methods A total of 1,548 ESRD patients were enrolled and were divided into quartiles according to CRP/albumin levels at initiation of HD; quartile 1 (Q1): <0.22, Q2: 0.23–0.54, Q3: 0.55–1.83 and Q4: >1.84. They were followed up for 10-year after starting HD therapy. Primary endpoint was CV events defined as hospitalization due to CV events such as cardiac disease, stroke and peripheral artery disease and CV death. We also evaluated the incremental value with C-index when CRP alone, albumin alone and the CRP/albumin ratio were added into a model with established risk factors. Results During follow-up period (median: 59 months), 512 cases experienced CV events (33.1%) including 165 cases of CV deaths (10.7%). Kaplan-Meier analysis shows that CV event-free survival rates for 10 years were 63.5%, 53.8%, 47.5% and 31.9% in Q1, Q2, Q3 and Q4, and that CV survival rates were 90.4%, 83.9%, 77.2% and 64.6% in Q1, Q2, Q3 and Q4, respectively (p<0.0001 in both). After adjustment for all baseline variables, elevated CRP/albumin ratio was identified as an independent predictor for CV events [hazard ratio (HR) 1.51, 95% confidence interval (CI) 1.11–2.07, p=0.0093 for Q2 vs. Q1, HR 1.79, 95% CI 1.33–2.42, p<0.0001 for Q3 vs. Q1and HR 2.27, 95% CI 1.70–3.07, p<0.0001 for Q4 vs. Q1, respectively]. As to CV mortality, similar results were obtained (HR 1.80, 95% CI 0.98–3.44, p=0.056 for Q2 vs. Q1, HR 2.56, 95% CI 1.45–4.71, p=0.0009 for Q3 vs. Q1 and HR 2.66, 95% CI 1.53–4.86, p=0.0004 for Q4 vs. Q1, respectively). Furthermore, adding the CRP/albumin ratio to a baseline model with established risk factors improved the C-index greater than that of CRP alone or albumin alone, respectively (0.715 from 0.692, p=0.0095 and from 0.683, p=0.0019) Conclusion The CRP/albumin ratio, which easily available from daily practice, could strongly stratify the risk of future CV morbidity and mortality in ESRD patients who need HD therapy.

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Association of Prenatal Famine Exposure With Inflammatory Markers and Its Impact on Adulthood Liver Function Across Consecutive Generations

Frontiers in Nutrition ◽

10.3389/fnut.2021.758633 ◽

2022 ◽

Vol 8 ◽

Author(s):

Shiwei Yan ◽

Jingqi Ruan ◽

Yu Wang ◽

Jiaxu Xu ◽

Changhao Sun ◽

...

Keyword(s):

Liver Function ◽

Inflammatory Markers ◽

Necrosis Factor Alpha ◽

Mixed Effect ◽

Reactive Protein ◽

Mixed Effect Models ◽

Tnf Α ◽

Factor Alpha ◽

Famine Exposure ◽

Prenatal Famine

Although there has been increasing recognition that famine exposure in the fetal stage damages liver function in adulthood, this deteriorated effect could be extended to the next generation remains vague. This study aimed to explore whether famine exposure was associated with liver function in the two consecutive generations, and its association with the mediation role of inflammatory markers. We analyzed the data of 2,681 participants from Suihua rural area, Heilongjiang Province, China. According to the date of birth, the participants were classified as fetal exposed and nonexposed. The F2 subjects were classified as having no parents exposed to famine, maternal famine exposure, paternal famine exposure, or parental famine exposure. In the mixed-effect models, prenatal exposure to famine was associated with the elevation of Δ aspartate aminotransferase (ΔAST) (β: 0.22, 95% CI: 0.01, 0.43) and Δ alanine aminotransferase (ΔALT) (β: 0.42, 95% CI: 0.19, 0.66) levels in F1 adults. The mediation analysis showed that the inflammatory markers including serum C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α) might mediate the famine-liver function association. This longitudinal data were consistent with the hypothesis that the inflammatory markers explained part of the influence of prenatal famine exposure on liver function injury, and the natal mechanism was needed to be elucidated in the future study.

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Abstract #58: Synergistic Effects of Simvastatin and Pioglitazone on Inflammatory Cytokines Interferon-gamma, Tumor Necrosis Factor-alpha, Interleukin-6 and C-reactive Protein in Diabetic Patients with Hyperlipidemia and Coronary Artery Disease

Endocrine Practice ◽

10.1016/s1530-891x(20)46337-2 ◽

2004 ◽

Vol 10 ◽

pp. 21

Author(s):

Stanley A. Tan ◽

Linda G. Tan

Keyword(s):

Coronary Artery Disease ◽

Tumor Necrosis ◽

Synergistic Effects ◽

Diabetic Patients ◽

C Reactive Protein ◽

Necrosis Factor Alpha ◽

Reactive Protein ◽

Factor Alpha ◽

Artery Disease ◽

Necrosis Factor

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Prediction of All-Cause Mortality Using an Echocardiography-Based Risk Score in Hemodialysis Patients

Cardiorenal Medicine ◽

10.1159/000507727 ◽

2020 ◽

pp. 1-11

Author(s):

Jing Zhu ◽

Chao Tang ◽

Han Ouyang ◽

Huaying Shen ◽

Tao You ◽

...

Keyword(s):

Risk Factors ◽

Cox Model ◽

Prognostic Score ◽

Basic Model ◽

Risk Of Mortality ◽

All Cause Mortality ◽

Cardiac Valve Regurgitation ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Aim: To derive an echocardiography-based prognostic score for a 3-year risk of mortality in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). Methods: 173 ESRD patients hospitalized in the second affiliated hospital of Soochow University from January 1, 2010, to July 31, 2016, were enrolled and followed up for 3 years. All subjects began to receive HD from recruitment. Baseline clinical and echocardiographic parameters were collected and screened for risk factors using univariate and multivariate analysis. The prognostic value of echocardiographic indexes was determined by concordance indexes and reclassification assay. Restricted cubic spline models (RCS) and forest plots were employed to visualize the association between risk factors and all-cause mortality. A multivariate nomogram including the identified factors was developed to estimate the prognosis. Results: After multivariate adjustment for advanced age, hypertension, diabetes, and decreased hemoglobin (Hb), echocardiographic indexes including left atrial diameter index (LADI), cardiac valvular calcification, and moderate to severe cardiac valve regurgitation were independently associated with the risk of 3-year mortality in HD patients. RCS showed that age, Hb, and LADI were positively associated with the risk of mortality. Adding multiple echocardiographic indexes to a basic model containing age, hypertension, diabetes, and Hb increased the concordance index and improved reclassification. A multivariate Cox model-derived nomogram showed the association between each factor and mortality by the end of follow-up. Conclusions: Echocardiographic indexes showed independent predictive power for mortality in ESRD patients and may constitute a promising prognostic tool in this population.

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