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Cardiovascular disease in haemodialysis: role of the intravascular innate immune system
Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences. Uppsala University. (Linnaeus Centre for Biomaterials Chemistry)ORCID iD: 0000-0001-7888-1571
Uppsala University.
Uppsala University.
Uppsala University.
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2017 (English)In: Nature Reviews Nephrology, ISSN 1759-5061, E-ISSN 1759-507X, Vol. 13, no 5, 285-296 p.Article, review/survey (Refereed) Published
Abstract [en]

Haemodialysis is a life-saving renal replacement modality for end-stage renal disease, but this therapy also represents a major challenge to the intravascular innate immune system, which is comprised of the complement, contact and coagulation systems. Chronic inflammation is strongly associated with cardiovascular disease (CVD) in patients on haemodialysis. Biomaterial-induced contact activation of proteins within the plasma cascade systems occurs during haemodialysis and initially leads to local generation of inflammatory mediators on the biomaterial surface. The inflammation is spread by soluble activation products and mediators that are generated during haemodialysis and transported in the extracorporeal circuit back into the patient together with activated leukocytes and platelets. The combined effect is activation of the endothelium of the cardiovascular system, which loses its anti-thrombotic and anti-inflammatory properties, leading to atherogenesis and arteriosclerosis. This concept suggests that maximum suppression of the intravascular innate immune system is needed to minimize the risk of CVD in patients on haemodialysis. A potential approach to achieve this goal is to treat patients with broad-specificity systemic drugs that target more than one of the intravascular cascade systems. Alternatively, 'stealth' biomaterials that cause minimal cascade system activation could be used in haemodialysis circuits.

Place, publisher, year, edition, pages
Nature Publishing Group, 2017. Vol. 13, no 5, 285-296 p.
National Category
Immunology in the medical area
Research subject
Biomedical Sciences, Immunology
Identifiers
URN: urn:nbn:se:lnu:diva-64189DOI: 10.1038/nrneph.2017.17ISI: 000399003200005PubMedID: 28239169OAI: oai:DiVA.org:lnu-64189DiVA: diva2:1097935
Available from: 2017-05-23 Created: 2017-05-23 Last updated: 2017-05-23Bibliographically approved

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Nilsson Ekdahl, KristinaNilsson, Bo
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CiteExportLink to record
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