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Inflammation in Chronic Kidney Disease Page Oxidative stress is often cited as an important mediator of tissue damage. People who have chronic kidney disease (CKD) are prone to atherosclerosis and cardiovascular events. Oxidative stress is highly prevalent in patients with CKD and even more common in patients with end-stage renal disease (ESRD).

Factors such as age, diabetes, hypertension, inflammation, incompatibility of dialysis membranes, and dialysate solutions, together with lower antioxidant defense (reduced activity of the glutathione system, low levels of vitamins E and C), can contribute to oxidative stress. In patients with CKD, oxidative stress has been linked to several surrogate markers of atherosclerosis such as endothelial dysfunction and intima-media thickness. Unfortunately, there are few large epidemiological studies testing hard endpoints.

However, oxidative stress might also influence response to erythropoiesis-stimulating agents (ESAs), possibly by reducing the natural life span of red blood cells and iron metabolism. ESA dose could be a practical marker to use in a clinical setting, as well as in clinical studies.

  • FACT ONE - Multiple factors such as hemodialysis, catheter placement, infections, and ischemia are known to cause inflammation, which is associated with higher rates of morbidity and a poorer quality of life.
  • FACT TWO - For patients with CKD, chronic inflammation is associated with higher morbidity-related issues such as malnutrition and cardiovascular disease.
  • FACT THREE - Inflammation is associated with higher ESA doses, which could result in suboptimal outcomes and significantly higher costs (Bárány et al. 1997, Smith et al. 2010).
  • FACT FOUR - A number of recently published clinical studies have reported that the use of certain antioxidants is associated with a significant reduction in inflammation biomarkers such as C-reactive protein (Matias et al. 2010, Bucharles et al. 2012, Khabbazi et al. 2012).
  • FACT FIVE – Oxidative stress increases as CKD progresses. There is evidence that antioxidative therapy could be of particular benefit in patients on dialysis (Jun et al. 2012).