The Latest Addition to the Inflammatory Homeboys in Chronic Kidney Disease: Interleukin-8

Abstract

Deutsche Diabetes Dialyse Studie ) [4] , in which atorvastatin had no short-term or long-term effect on survival in diabetic dialysis patients. In fact, the known cardiovascular risk factors such as hypercholesterolemia paradoxically confer survival advantages in dialysis patients, a phenomenon known as ‘reverse epidemiology’ [5]. Hence, there must be other predominating conditions which are specifi c to dialysis patients and which have much stronger impact on survival of dialysis patients than Framingham risk factors. Malnutrition-infl ammation-cachexia (or complex) syndrome (MICS) is a common condition in dialysis patients and has a strong association with poor outcome and death. To date, no single measurement has been found to have stronger association with mortality than serum albumin, a nutritional visceral protein and a negative acute phase reactant [6] . Similarly, serum C-reactive protein (CRP) and some circulating pro-infl ammatory cytokines such as interleukin (IL)-6 are other indicators of MICS and are associated with death risk in dialysis patients [7] . However, the association between other circulating cytokines such as tumor necrosis factorand mortality has not been clearly or consistently shown in these patients [7, 8] . Moreover, although the utility of non-laboratory surrogates of MICS including erythropoietin hyporesponsiveness or ‘malnutrition-infl ammation score’ in predicting poor outcome have also been studied, the reliDespite many technical, clinical and scientifi c advances at the dawn of the 21st century, individuals with chronic kidney disease (CKD) undergoing maintenance dialysis continue to have a high mortality, currently approximately 15–20% per year in North America and Europe [1] . Conventional cardiovascular risk factors have been the target of practice guidelines based on the following three premises: (1) almost half of all excess deaths in dialysis patients are cardiovascular; (2) some cardiovascular risk factors such as hypertension, hyperhomocysteinemia and obesity are excessively common in dialysis patients, and (3) in the general population, classical cardiovascular risk factors have established links to clinical outcome. Based on this traditional way of thinking, the recent Kidney Disease Outcome Quality Initiative (K/DOQI) Guidelines on Cardiovascular Disease in Dialysis Patients [2] have continued the ongoing obsession of focusing on classical cardiovascular risk factors, despite the fact that decades of concentrating on Framingham guidelines that originate from the healthy general population data have not resulted in any major improvement in dialysis mortality. Moreover, both observational studies and clinical trials have consistently indicated the lack of conventional associations between mortality and such cardiovascular risk factors as hypercholesterolemia and hyperhomocysteinemia [3] . The most prominent negative clinical trial of recent origin is the 4D Study ( Die Published online: October 13, 2005