Sun Phyllis P, Perianayagam Mary C, Jaber Bertrand L
Kidney and Dialysis Research Laboratory, Division of Nephrology, Department of Medicine, St Elizabeth's Medical Center, Boston, Massachusetts 02135, USA.
Kidney Int Suppl. 2009 Dec(114):S20-5. doi: 10.1038/ki.2009.403.
Chronic inflammation is highly prevalent in patients with chronic kidney disease (CKD), and is associated with increased cardiovascular morbidity and mortality. There are numerous causes of inflammation in CKD, including the potential exposure to bacterial lipopolysaccharide (LPS) in the bloodstream from the intestinal tract as a result of uremia-related increases in intestinal permeability. Sevelamer, a commonly prescribed non-calcium, non-metal-based phosphate binder in CKD, also possesses putative anti-inflammatory properties, as its use has been associated with a reduction in systemic markers of inflammation. Emerging studies have provided direct evidence that sevelamer shows in vitro LPS-binding properties. Indirect clinical evidence suggests that sevelamer might also limit translocation of LPS from the intestinal lumen into the bloodstream. This review focuses on bacterial LPS as a source of chronic inflammation in CKD, and proposes that sevelamer might possess novel anti-inflammatory properties as a result of LPS binding in the intestinal tract. The proposed hypothesis that intestinal LPS-binding by sevelamer may lower circulating LPS, and in turn systemic inflammation, requires further evaluation in a clinical trial.
慢性炎症在慢性肾脏病（CKD）患者中极为普遍，且与心血管疾病发病率和死亡率的增加相关。CKD炎症有多种原因，包括因尿毒症相关的肠道通透性增加导致肠道中的细菌脂多糖（LPS）可能进入血液循环。司维拉姆是CKD中常用的一种非钙、非金属基磷酸盐结合剂，也具有假定的抗炎特性，因为其使用与炎症的全身标志物减少有关。新兴研究提供了直接证据，表明司维拉姆具有体外LPS结合特性。间接临床证据表明，司维拉姆还可能限制LPS从肠腔向血液的转运。本综述聚焦于细菌LPS作为CKD慢性炎症的一个来源，并提出司维拉姆可能由于在肠道中结合LPS而具有新的抗炎特性。关于司维拉姆在肠道中结合LPS可能降低循环LPS，进而降低全身炎症的假设，需要在临床试验中进一步评估。
