Causes and consequences of the chronic inflammatory state in chronic dialysis patients

Recent prospective studies have shown that several markers of systemic infl ammation may be used to predict future cardiovascular events. High-sensitiv ity testing for C-reactive protein has received most of the attention. We m easured serum CRP in a total number of 312 patients on hemodialysis in comp arison with 300 sex matched healthy controls. We found, that a considerable number of hemodialysis patients exhibit an activated acute phase response (8-fold higher CRP levels in hemodialysis patients than in controls), which is closely related to high levels of atherogenic vascular risk factors and cardiovascular death. The mechanisms of activated acute phase reaction in patients on chronic hemodialysis remain to be identified, since a successfu l treatment of the inflammatory condition may improve long-term survival in these patients. Two major questions need to be clarified: 1) Should we sea rch for a stimujlatory factor chat is dialysis dependent? or 2) Should we s upport the hypothesis that a systemic factor, uremia related or altered by uremia, is responsible for the high CRP levels in hemodialysis patients?