Gut Microbial Translocation in the Pathogenesis of Systemic Inflammation in Patients with End-Stage Renal Disease

Excerpt

Chronic kidney disease (CKD) accelerates cardiovascular disease, increases the incidence and severity of microbial infections, anemia, cachexia and numerous other morbidities that shorten the life span and greatly impair the quality of patients’ lives. These abnormalities are associated with and are largely mediated by systemic inflammation and oxidative stress, common features of CKD [1], which have been attributed to numerous factors [2]. The severity of CKD-associated systemic inflammation correlates directly with the magnitude of endotoxemia in the absence of clinically detectable infection [3]. Although presence of endotoxin in the blood of ESRD patients was attributed to dialysate contamination, its presence in patients who do not receive dialysis treatment and in animals with experimental renal failure supports its endogenous origin, the most likely source being the gastrointestinal tract, home to a huge microbial community. This assumption is supported by several studies which have reported the presence of gut bacterial DNA fragments in the blood of CKD patients maintained on hemodialysis [4] and in CKD patients who did not receive dialysis treatment [5]. Moreover, colonic bacterial DNA has been detected in the mesenteric lymph nodes, blood, liver and spleen of animals with experimental CKD [6]. …