Baragetti Ivano, El Essawy Basset, Fiorina Paolo
Nephrology Division, Bassini Hospital, Milan, Italy.
Am J Nephrol. 2017;45(4):310-319. doi: 10.1159/000458768. Epub 2017 Feb 25.
Despite the stable incidence of end-stage renal disease (ESRD), it continues to be associated with an unacceptably high cardiovascular risk.
ESRD is characterized by enhanced oxidative stress and severe inflammation, which boost cardiovascular risk, thus increasing cardiovascular-associated mortality rate. While substantial effort has been made in the technological innovation of dialytic techniques, few significant advances have been made to reduce inflammation in patients with ESRD. Indeed, this contrasts with the extensive scientific breakthroughs made in the basic field of science in targeting inflammation. There is thus a pressing need for clinical trials to test the effect of reducing inflammation in patients with ESRD. Here, we will revisit the negative effect of ESRD on inflammation and explore the impact of enhanced inflammation on cardiovascular outcomes and survival in patients with ESRD. Finally, we will discuss the need for clinical trials that target inflammation in ESRD, as well as weigh potential disadvantages and offer novel innovative approaches. Key Message: We will try to understand why the issue of inflammation has not been successfully addressed thus far in patients with ESRD, while at the same time weighing the potential disadvantages and offering novel innovative approaches for targeting inflammation in patients with ESRD.
尽管终末期肾病（ESRD）的发病率稳定，但它仍然与高得令人难以接受的心血管风险相关。
ESRD的特征是氧化应激增强和严重炎症，这会增加心血管风险，从而提高心血管相关死亡率。虽然在透析技术的技术创新方面已经付出了巨大努力，但在降低ESRD患者炎症方面几乎没有取得重大进展。事实上，这与基础科学领域在针对炎症方面取得的广泛科学突破形成了对比。因此，迫切需要进行临床试验来测试减轻ESRD患者炎症的效果。在此，我们将重新审视ESRD对炎症的负面影响，并探讨炎症增强对ESRD患者心血管结局和生存的影响。最后，我们将讨论针对ESRD炎症进行临床试验的必要性，权衡潜在的不利因素，并提供新颖的创新方法。关键信息：我们将试图理解为什么迄今为止ESRD患者的炎症问题尚未得到成功解决，同时权衡潜在的不利因素，并为针对ESRD患者的炎症提供新颖的创新方法。
