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Treating inflammation to improve outcome in dialysis patients

Uremia is a systemic inflammatory condition characterized by a combination of oxidative burst, uremic toxicity, uremic dyslipidemia, endothelial dysfunction and oxidative stress resulting from dysfunctional mitochondrial electron transfer generating reactive oxygen species. These compounds induce oxidative modifications of carbohydrates (AGEs), proteins, lipids and DNA, in turn recognized as DAMPs by Toll-like receptors (TLRs), which in end-stage renal disease (ESRD) are upregulated in many cell types including macrophages and neutrophils. All the inflammatory derangements typical of ESRD lead to an increased cardiovascular risk in dialysis patients. Unfortunately, the technological innovations in dialysis techniques have not given rise to a better prognosis for patients with ESRD, probably because they have had no favorable effect on inflammation in the uremic milieu. Presenting a recent review by Baragetti and coworkers published in Am J Nephrol 2017 and the results of a PubMed search with “antiinflammatory drug hemodialysis”, “oxidative stress drugs hemodialysis” and “endothelial dysfunction drug hemodialysis” as keywords, we would like to offer a novel and innovative approach to targeting uremic inflammation considering data from clinical trials.