The Role of Inflammation in Chronic Kidney Disease

Abstract

The morbidity and mortality rate of patients with chronic kidney disease (CKD) remain high despite progressive development in CKD management. Microinflammation is an important component of CKD, and has an important role in the pathophysiology of cardiovascular disease (CVD) complications, as well as protein energy deficiency (PED) and mortality. Various factors contributes to the inflammatory state of CKD, including increased production and decreased excretion of pro-inflammatory cytokines, oxidative stress, acidosis, chronic vascular access infection, fat metabolism dysregulation, and intestinal dysbiosis. The inflammatory process has been shown to be directly correlated with glomerular filtration rate (GFR) in CKD and reaches its peak in end-stage renal disease (ESRD). A number of dialysis-related factors such as bioincompatible membranes and dialysate quality also have important roles in the inflammatory process. Meanwhile, the role of genetic and epigenetic factors is being widely studied. Efforts in reducing inflammation such as lifestyle modification, medication, and dialysis optimization have been performed and tested into a controlled clinical trial.