Endotoxemia as a Risk Factor in Systemic Inflammation and Cardiovascular Disease in Patients on Maintenance Hemodialysis

Abstract

Bacterial endotoxin is a lipopolysaccharide (LPS) which represents the major glycolipid component of the outer membrane of gram-negative bacteria and accounts for 70% of the total bacteria in the healthy human gut. Translocated endotoxin derived from intestinal bacteria has a wide range of adverse effects on cardiovascular (CV) structure and function, driving systemic inflammation, atherosclerosis and oxidative stress Chronic kidney disease (CKD) patients are characteristically exposed to significant endotoxemia. In particular, Hemodialysis (HD)-induced systemic circulatory stress and recurrent regional ischemia may lead to increased endotoxin translocation from the gut. Resultant endotoxemia is associated with systemic inflammation, markers of malnutrition, cardiac injury, and reduced survival. This represents a crucial missing link in understanding the pathophysiology of the grossly elevated CV disease risk in CKD patients, highlighting the potential toxicity of conventional HD and providing a novel set of potential therapeutic strategies to reduce CV mortality in CKD patients In our study , we assess the endotoxemia across the spectrum of HD patients and find its association to IHD Our Study was Case control study. The study was conducted on 120 patients on maintenance HD. The patients were recruited from Ain Shams University Hospitals (Hemodialysis units) .