Abstract
Access to renal transplantation guarantees a substantial improvement in the clinical condition and quality of life (QoL) for end-stage renal disease (ESRD) patients. In recent years, a greater number of older patients starting renal replacement therapies (RRT) have shown the long-term impact of conservative therapies for advanced CKD and the consequences of the uremic milieu, with a frail clinical condition that impacts not only their survival but also limits their access to transplantation. This process, referred to as “inflammaging,” might be reversible with a tailored approach, such as RRT accompanied by specific nutritional support. In this review, we summarize the evidence demonstrating the presence of several proinflammatory substances in the Western diet (WD) and the positive effect of unprocessed food consumption and increased fruit and vegetable intake, suggesting a new approach to reduce inflammaging with the improvement of ESRD clinical status. We conclude that the Mediterranean diet (MD), because of its modulative effects on microbiota and its anti-inflammaging properties, may be a cornerstone in a more precise nutritional support for patients on the waiting list for kidney transplantation.
Highlights
Inflammation is a typical feature of end-stage renal disease (ESRD) and contributes to cardiovascular disease (CVD), protein-energy wasting (PEW) and premature death [1,2,3].ERSD is linked to a chronic proinflammatory cytokine production and reduced clearance due to the progressive renal failure with retention of high molecular weight toxins and protein bund toxins (PBUT) that are responsible for oxidative damage
The modulation of inflammaging processes might be at the center of a multidisciplinary scientific debate, with the primary objective to reduce red meat consumption and increase dietary fiber, leading to a modulation of macronutrients intake to improve the clinical conditions of patients in renal replacement therapies (RRT) waiting for kidney transplantation [7]
This chronic inflammatory condition is characterized by a progressive alteration of the resident microbes of the gut, the microbiota, and by its gene heritage and coding capacity connected to the environment, the microbiome, exerting a pivotal role promoting or sustaining CVD, inflammatory bowel disease (IBD), diabetes, obesity, cancer, and malnutrition [98]
Summary
Inflammation is a typical feature of end-stage renal disease (ESRD) and contributes to cardiovascular disease (CVD), protein-energy wasting (PEW) and premature death [1,2,3]. Renal Replacement Therapies (RRT), this inflammatory state is worsened by overhydration, poor dialyzer membrane biocompatibility, anticoagulation, vascular inflammation, and comorbidities such as diabetes, hypertension, obesity, malnutrition, and heart failure [4]. It has been recognized the possibility of a nutritional approach tailored to deal with this state of persistent, low-grade, chronic inflammation by reducing proinflammatory cytokines levels such as IL-1B, IL-6, IL-8, and IL-18 [5,6]. The modulation of inflammaging processes might be at the center of a multidisciplinary scientific debate, with the primary objective to reduce red meat consumption and increase dietary fiber, leading to a modulation of macronutrients intake to improve the clinical conditions of patients in RRT waiting for kidney transplantation [7]
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