DESCRIPTION:
Chronic inflammation has been linked to the development of several medium to long-term morbidities in ESRD patients on regular extracorporeal treatment. This publication discusses aspects of several biological mechanisms relevant to the triggering and maintenance of such a chronic inflammatory state.
Cardiovascular disease is the leading cause of mortality in patients on hemodialysis: The inflammatory process is instrumental not only to the triggering, but also to the persistence of the different factors (activated cells, modified proteins) capable of initiating vascular damage. In this context, recently demonstrated increased levels of the highly pro-atherosclerotic electronegative form of LDL (LDL-) in hemodialysis patients are strongly suggestive of a relevant role of oxidative mechanisms. Moreover, apart from the mechanisms apparent from hemoincompatibility-related phenomena, a novel implication of hemoglobin (heme-)induced cross-linking with tyrosine residues of LDL may provide a fresh interest in the often-neglected microhemolysis in hemodialysis. Another important issue is the role of backfiltration of contaminated dialysate (within the AAMI standards) as a chronic stimulus for cytokine production and chronic inflammation. Apart from discussing strategies to avoid this phenomenon, it is also pointed out that dialysate microbiological purity is absolutely mandatory to avert possible disastrous effects.
