Document Detail

Associations between renal function, volume status and endotoxaemia in chronic kidney disease patients.
MedLine Citation:
PMID:  16861246     Owner:  NLM     Status:  MEDLINE    
Inflammation is an important predictor of increased cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD), but the mechanisms behind the chronic activation of the immune system are not clearly understood. CKD patients develop fluid overload, which has been proposed to be a stimulus for inflammatory activation due to the translocation of macromolecules from the gut. We hypothesize that fluid overload is associated with signs of systemic inflammation and endotoxaemia in stages 1-5 CKD patients. The aim of this prospective study was to evaluate the associations between renal function, fluid status [evaluated by the inferior vena cava diameter (IVCD) and the collapsibility index (CI)], systemic inflammation [plasma levels of C-reactive protein (CRP), fibrinogen and albumin] and endotoxaemia (through the Limulus amebocyte lysate enzymatic assay) in a group of CKD patients in our out-patient clinic. The population consisted of 74 (mean of 57; range 23-83 years of age; 47% males) CKD patients with glomerular filtration rate (based on the mean of urea and creatinine clearances) of 34 ml/min. Both albumin (Rho = 0.25; P = 0.05) and fibrinogen (Rho= - 0.48; P < 0.0001) were significantly correlated to glomerular filtration rate (GFR). According to the IVCD, 84% of the patients were fluid overloaded, while 83% were considered overloaded by the CI. Signs of endotoxaemia were detected in all patients. Endotoxin levels were higher in patients with signs of fluid overload (0.85 +/- 0.11ng/l) when compared with patients with normal values of IVCD (0.61 +/- 0.05 ng/l; P < 0.05). Endotoxin levels correlated to both IVCD (Rho=0.33, P < 0.005) and CI (Rho = -0.25, P < 0.05). There was no correlation between endotoxin levels and GFR, CRP or fibrinogen. In summary, although most CKD patients presented signs of fluid overload that was associated with endotoxaemia, there was no association between endotoxaemia and systemic inflammation, suggesting the endotoxaemia may not be the main determinant of the inflammatory status in this group of patients.
Simone Gonçalves; Roberto Pecoits-Filho; Sônia Perreto; Silvio H Barberato; Andréa E M Stinghen; Emmanuel G A Lima; Roseana Fuerbringer; Sirlene M Sauthier; Miguel C Riella
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2006-07-21
Journal Detail:
Title:  Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association     Volume:  21     ISSN:  0931-0509     ISO Abbreviation:  Nephrol. Dial. Transplant.     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-09-20     Completed Date:  2007-04-02     Revised Date:  2008-01-14    
Medline Journal Info:
Nlm Unique ID:  8706402     Medline TA:  Nephrol Dial Transplant     Country:  England    
Other Details:
Languages:  eng     Pagination:  2788-94     Citation Subset:  IM    
Centro de Ciências Biológicas e da Saúde, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155 Curitiba, PR 80215-901, Brazil.
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MeSH Terms
C-Reactive Protein / metabolism
Creatinine / metabolism
Cross-Sectional Studies
Disease Progression
Endotoxemia / metabolism*,  pathology,  physiopathology
Endotoxins / metabolism
Fibrinogen / metabolism
Glomerular Filtration Rate
Inflammation / metabolism,  pathology,  physiopathology
Kidney / metabolism*,  pathology,  physiopathology
Kidney Failure, Chronic / metabolism*,  pathology,  physiopathology
Linear Models
Middle Aged
Reg. No./Substance:
0/Endotoxins; 60-27-5/Creatinine; 9001-32-5/Fibrinogen; 9007-41-4/C-Reactive Protein
Comment In:
Nephrol Dial Transplant. 2007 Oct;22(10):3088-9; author reply 3089   [PMID:  17452416 ]

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