Monitoring of inflammation in patients on dialysis: forewarned is forearmed
Levels of serum inflammatory biomarkers—such as C-reactive protein—fluctuate substantially over time in patients undergoing dialysis. Monitoring these changes could provide us with useful information concerning the underlying processes that cause inflammation. In this Review, Meuwese and colleagues...
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| Published in: | Nature reviews. Nephrology Vol. 7; no. 3; pp. 166 - 176 |
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| Main Authors: | , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
London
Nature Publishing Group UK
01-03-2011
Nature Publishing Group |
| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Levels of serum inflammatory biomarkers—such as C-reactive protein—fluctuate substantially over time in patients undergoing dialysis. Monitoring these changes could provide us with useful information concerning the underlying processes that cause inflammation. In this Review, Meuwese and colleagues examine the implications and causes of inflammatory marker variability in patients on dialysis, and discuss the advantages of repeated measurements of inflammation over single measurements in clinical practice.
Current evidence about the effects of inflammation on the outcomes of patients with advanced chronic kidney disease (CKD) generally originates from single measurements of inflammatory biomarkers. Patients with CKD, however, are exposed to persistent low-grade inflammation and levels of serum inflammatory markers are subjected to a substantial variability over time, being influenced by multiple processes, such as transient infections, comorbidities, and the intermittent stimulus of dialysis. Understanding and evaluating inflammation in the context of its time-dependent oscillations in renal disease fluctuation is, therefore, important. Nevertheless, the relationship between longitudinal inflammatory variation and risk prediction has so far been addressed in only a few studies, not all of which have been sufficiently powered. Consequently, uncertainty exists about how to interpret the findings of these studies in the clinical setting. The purpose of this Review is to explore the reasons and implications of variability in levels of inflammatory biomarkers in patients with uremia, specifically focusing on C-reactive protein (CRP) measurements. We also discuss the value of repeated versus single measurements of inflammation in the clinical setting and provide solutions to reduce both sample size and intraindividual variability in hypothetical, randomized controlled trials aimed at reducing CRP levels in patients undergoing hemodialysis.
Key Points
In patients with end-stage renal disease, inflammatory markers are subject to substantial variability over time, and are influenced by transient infections, comorbidities, and the intermittent stimulus of dialysis
Insufficient evidence exists about the implications of regular C-reactive protein (CRP) screening in patients undergoing dialysis; multiple measures of CRP seem to offer predictive advantages with single determinations
Regular CRP screening could identify short-term variation in levels of inflammatory markers associated with mortality, which could facilitate risk stratification of patients with chronic kidney disease
Regular CRP screening for individual patients could enable extensive exploration of underlying causes of inflammation and the assignment of appropriate treatment
When designing a randomized controlled trial to lower CRP level in patients on hemodialysis, sample size and intrapatient variability can be reduced by estimating inflammation at each time point with averaged measurements for each individual |
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| Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1 |
| ISSN: | 1759-5061 1759-507X 1759-507X |
| DOI: | 10.1038/nrneph.2011.2 |