Inflammation in end-stage renal failure: could it be treated?

End-stage renal disease (ESRD) is characterized by an exceptional mortality rate, much of which is the result of cardiovascular disease (CVD). Although traditional risk factors are common in ESRD patients, they may not be sufficient alone to account for the high prevalence of CVD in this condition. Recent evidence demonstrates that chronic inflammation, a non-traditional risk factor which is observed commonly in ESRD patients, may cause malnutrition and progressive atherosclerotic CVD by several pathogenetic mechanisms. The causes of inflammation in ESRD are multifactorial and, while it may reflect underlying CVD, an acute-phase reaction may also be a direct cause of vascular injury by several pathogenetic mechanisms. Available data suggest that pro-inflammatory cytokines play a central role in the genesis of both malnutrition and CVD in ESRD. Thus, it could be speculated that suppression of the vicious cycle of malnutrition, inflammation and atherosclerosis (MIA) would improve survival in dialysis patients. Recent evidence has demonstrated strong associations between inflammation and both increased oxidative stress and endothelial dysfunction in ESRD patients. As there is as yet no recognized, or even proposed, treatment for ESRD patients with chronic inflammation, it would be of obvious interest to study the long-term effect of various anti-inflammatory treatment strategies on the nutritional and cardiovascular status as well as the outcome in these patients.