Endotoxin Binding by Sevelamer: Potential Impact on Nutritional Status
Patients on hemodialysis (HD) have a high burden of chronic inflammation induced associated with multiple comorbidities including poor nutritional status. Endotoxin (ET) is a Gram-negative bacterial cell wall component and a potent stimulus for innate immune system activation leading to the transcri...
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| Format: | Article |
| Language: | English |
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Wiley
2013-01-01
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| Series: | International Journal of Nephrology |
| Online Access: | http://dx.doi.org/10.1155/2013/954956 |
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| author | Natsuki Kubotera Alexander J. Prokopienko Adinoyi O. Garba Amy Barton Pai |
| author_facet | Natsuki Kubotera Alexander J. Prokopienko Adinoyi O. Garba Amy Barton Pai |
| author_sort | Natsuki Kubotera |
| collection | DOAJ |
| description | Patients on hemodialysis (HD) have a high burden of chronic inflammation induced associated with multiple comorbidities including poor nutritional status. Endotoxin (ET) is a Gram-negative bacterial cell wall component and a potent stimulus for innate immune system activation leading to the transcription of proinflammatory cytokines (e.g., IL-1, IL-6, and TNFα) that adversely affect protein metabolism and nutrition. Several cross-sectional observational studies have found that elevated serum ET concentrations in hemodialysis patients are associated with lower serum albumin, higher proinflammatory cytokine, and C-reactive protein concentrations. Possible sources of ET in the systemic circulation are bacterial translocation from the gastrointestinal tract and iron supplementation, potentially leading to intestinal bacterial overgrowth. Sevelamer is a nonabsorbable hydrogel approved for use as a phosphate binder in HD patients. Reductions in serum ET concentrations in hemodialysis patients have been observed with sevelamer therapy in observational studies and the few published interventional studies. Reduction of ET concentrations was associated with concomitant reductions in TNFα, IL-6, and CRP and improvement in serum albumin in the majority of these small studies. Additional studies are needed to evaluate the potential effects of sevelamer treatment on nutritional status in chronic kidney disease (CKD) patients with elevated ET. |
| format | Article |
| id | doaj-art-0a3ec01d6d1d43a797f2bc04918fe785 |
| institution | Kabale University |
| issn | 2090-214X 2090-2158 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | International Journal of Nephrology |
| spelling | doaj-art-0a3ec01d6d1d43a797f2bc04918fe7852025-08-20T03:55:27ZengWileyInternational Journal of Nephrology2090-214X2090-21582013-01-01201310.1155/2013/954956954956Endotoxin Binding by Sevelamer: Potential Impact on Nutritional StatusNatsuki Kubotera0Alexander J. Prokopienko1Adinoyi O. Garba2Amy Barton Pai3Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, 106 New Scotland Avenue, Albany, NY 12208, USADepartment of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, 106 New Scotland Avenue, Albany, NY 12208, USADepartment of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, 106 New Scotland Avenue, Albany, NY 12208, USADepartment of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, 106 New Scotland Avenue, Albany, NY 12208, USAPatients on hemodialysis (HD) have a high burden of chronic inflammation induced associated with multiple comorbidities including poor nutritional status. Endotoxin (ET) is a Gram-negative bacterial cell wall component and a potent stimulus for innate immune system activation leading to the transcription of proinflammatory cytokines (e.g., IL-1, IL-6, and TNFα) that adversely affect protein metabolism and nutrition. Several cross-sectional observational studies have found that elevated serum ET concentrations in hemodialysis patients are associated with lower serum albumin, higher proinflammatory cytokine, and C-reactive protein concentrations. Possible sources of ET in the systemic circulation are bacterial translocation from the gastrointestinal tract and iron supplementation, potentially leading to intestinal bacterial overgrowth. Sevelamer is a nonabsorbable hydrogel approved for use as a phosphate binder in HD patients. Reductions in serum ET concentrations in hemodialysis patients have been observed with sevelamer therapy in observational studies and the few published interventional studies. Reduction of ET concentrations was associated with concomitant reductions in TNFα, IL-6, and CRP and improvement in serum albumin in the majority of these small studies. Additional studies are needed to evaluate the potential effects of sevelamer treatment on nutritional status in chronic kidney disease (CKD) patients with elevated ET.http://dx.doi.org/10.1155/2013/954956 |
| spellingShingle | Natsuki Kubotera Alexander J. Prokopienko Adinoyi O. Garba Amy Barton Pai Endotoxin Binding by Sevelamer: Potential Impact on Nutritional Status International Journal of Nephrology |
| title | Endotoxin Binding by Sevelamer: Potential Impact on Nutritional Status |
| title_full | Endotoxin Binding by Sevelamer: Potential Impact on Nutritional Status |
| title_fullStr | Endotoxin Binding by Sevelamer: Potential Impact on Nutritional Status |
| title_full_unstemmed | Endotoxin Binding by Sevelamer: Potential Impact on Nutritional Status |
| title_short | Endotoxin Binding by Sevelamer: Potential Impact on Nutritional Status |
| title_sort | endotoxin binding by sevelamer potential impact on nutritional status |
| url | http://dx.doi.org/10.1155/2013/954956 |
| work_keys_str_mv | AT natsukikubotera endotoxinbindingbysevelamerpotentialimpactonnutritionalstatus AT alexanderjprokopienko endotoxinbindingbysevelamerpotentialimpactonnutritionalstatus AT adinoyiogarba endotoxinbindingbysevelamerpotentialimpactonnutritionalstatus AT amybartonpai endotoxinbindingbysevelamerpotentialimpactonnutritionalstatus |