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Inflammatory Cytokines as Uremic Toxins: "Ni Son Todos Los Que Estan, Ni Estan
Todos Los Que Son"
#MMPMID28333114
Castillo-Rodríguez E
; Pizarro-Sánchez S
; Sanz AB
; Ramos AM
; Sanchez-Niño MD
; Martin-Cleary C
; Fernandez-Fernandez B
; Ortiz A
Toxins (Basel)
2017[Mar]; 9
(4
): ? PMID28333114
show ga
Chronic kidney disease is among the fastest growing causes of death worldwide. An
increased risk of all-cause and cardiovascular death is thought to depend on the
accumulation of uremic toxins when glomerular filtration rate falls. In addition,
the circulating levels of several markers of inflammation predict mortality in
patients with chronic kidney disease. Indeed, a number of cytokines are listed in
databases of uremic toxins and uremic retention solutes. They include
inflammatory cytokines (IL-1?, IL-18, IL-6, TNF?), chemokines (IL-8), and
adipokines (adiponectin, leptin and resistin), as well as anti-inflammatory
cytokines (IL-10). We now critically review the cytokines that may be considered
uremic toxins. We discuss the rationale to consider them uremic toxins
(mechanisms underlying the increased serum levels and evidence supporting their
contribution to CKD manifestations), identify gaps in knowledge, discuss
potential therapeutic implications to be tested in clinical trials in order to
make this knowledge useful for the practicing physician, and identify additional
cytokines, cytokine receptors and chemokines that may fulfill the criteria to be
considered uremic toxins, such as sIL-6R, sTNFR1, sTNFR2, IL-2, CXCL12, CX3CL1
and others. In addition, we suggest that IL-10, leptin, adiponectin and resistin
should not be considered uremic toxins toxins based on insufficient or
contradictory evidence of an association with adverse outcomes in humans or
preclinical data not consistent with a causal association.