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Gut Bacterial Translocation May Aggravate Microinflammation in Hemodialysis Patients

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Abstract

Background/Aims

Bacterial translocation (BT) promotes microinflammation in predialysis patients with end-stage renal disease (ESRD). However, the change in BT has not been reported in ESRD patients undergoing regular hemodialysis treatment. The present study investigated whether hemodialysis promotes gut BT and microinflammation.

Methods

The blood, gut, and dialysate of hemodialysis patients were analyzed using bacterial 16S rDNA amplification and DNA pyrosequencing to determine the presence of bacteria and alteration in gut microbiomes. High-sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), and endotoxin were also determined. Plasma d-lactate was tested for gut permeability.

Results

Bacteria were present in the plasma of 12 out of 52 ESRD patients. The majority of the bacteria detected in the blood were also distributed in the gut of ESRD patients on the basis of the phylogenetics of the blood and gut microbial specimens in the patients. In patient, groups treated with and without hemodialysis, the plasma hs-CRP, IL-6, and endotoxin levels differed between the positive and negative plasma bacterial DNA. In patients who were positive in blood bacteria, the bacterial DNA concentration was positively correlated with plasma levels of CRP and IL-6. The ESRD patients who underwent hemodialysis had a different flora and showed slightly higher levels of hs-CRP, IL-6, and plasma endotoxin, compared with those in ESRD patients who did not undergo hemodialysis.

Conclusion

ESRD, rather than hemodialysis, primarily contributes to BT and microinflammation in ESRD patients. Hemodialysis may exaggerate microinflammation in ESRD patients to some extent.

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References

  1. Schindler R. Causes and therapy of microinflammation in renal failure[J]. Nephrol Dial Transpl. 2004;19:V34–V40.

    Article  CAS  Google Scholar 

  2. Zimmermann J, Herrlinger S, Pruy A, et al. Inflammation enhances cardiovascular risk and mortality in hemodialysis patients[J]. Kidney Int. 1999;55:648–658.

    Article  CAS  PubMed  Google Scholar 

  3. Kotanko P, Carter M, Levin NW. Intestinal bacterial microflora–a potential source of chronic inflammation in patients with chronic kidney disease[J]. Nephrol Dial Transpl. 2006;21:2057–2060.

    Article  Google Scholar 

  4. Wang F, Jiang H, Shi K, et al. Gut bacterial translocation is associated with microinflammation in end-stage renal disease patients[J]. Nephrology (Carlton). 2012;17:733–738.

    Article  CAS  Google Scholar 

  5. Wang F, Zhang P, Jiang H, et al. Gut bacterial translocation contributes to microinflammation in experimental uremia[J]. Dig Dis Sci. 2012;57:2856–2862.

    Article  CAS  PubMed  Google Scholar 

  6. Zimmermann J, Herrlinger S, Pruy A, et al. Inflammation enhances cardiovascular risk and mortality in hemodialysis patients[J]. Kidney Int. 1999;55:648–658.

    Article  CAS  PubMed  Google Scholar 

  7. Mcintyre CW, Harrison LE, Eldehni MT, et al. Circulating endotoxemia: a novel factor in systemic inflammation and cardiovascular disease in chronic kidney disease[J]. Clin J Am Soc Nephrol. 2011;6:133–141.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Zaza G, Granata S, Rascio F, et al. A specific immune transcriptomic profile discriminates chronic kidney disease patients in predialysis from hemodialyzed patients[J]. BMC Med Genomics. 2013;6:17.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Vaziri ND, Wong J, Pahl M, et al. Chronic kidney disease alters intestinal microbial flora[J]. Kidney Int. 2013;83:308–315.

    Article  PubMed  Google Scholar 

  10. Vaziri ND, Dure-Smith B, Miller R, et al. Pathology of gastrointestinal tract in chronic hemodialysis patients: an autopsy study of 78 cases[J]. Am J Gastroenterol. 1985;80:608–611.

    CAS  PubMed  Google Scholar 

  11. Bossola M, Sanguinetti M, Scribano D, et al. Circulating bacterial-derived DNA fragments and markers of inflammation in chronic hemodialysis patients[J]. Clin J Am Soc Nephrol. 2009;4:379–385.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Murphy MA, Kendall KC, Higbee JA. An evaluation of long-term preservation methods for brown bear (Ursus arctos) faecal DNA samples[J]. Conserv Genet. 2002;3:435–440.

    Article  CAS  Google Scholar 

  13. Gomila M, Gasco J, Gil J, et al. A molecular microbial ecology approach to studying hemodialysis water and fluid[J]. Kidney Int. 2006;70:1567–1576.

    Article  CAS  PubMed  Google Scholar 

  14. Bossola M, Sanguinetti M, Scribano D, et al. Circulating bacterial-derived DNA fragments and markers of inflammation in chronic hemodialysis patients[J]. Clin J Am Soc Nephrol. 2009;4:379–385.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Naaber P, Smidt I, Tamme K, et al. Translocation of indigenous microflora in an experimental model of sepsis[J]. J Med Microbiol. 2000;49:431–439.

    CAS  PubMed  Google Scholar 

  16. de Almeida DJ, de Aguilar-Nascimento JE, Nascimento M, et al. Bacterial translocation in experimental uremia[J]. Urol Res. 2004;32:266–270.

    Article  Google Scholar 

  17. Bossola M, Sanguinetti M, Scribano D, et al. Circulating bacterial-derived DNA fragments and markers of inflammation in chronic hemodialysis patients[J]. Clin J Am Soc Nephrol. 2009;4:379–385.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Merino A, Nogueras S, Garcia-Maceira T, et al. Bacterial DNA and endothelial damage in haemodialysis patients[J]. Nephrol Dial Transpl. 2008;23:3635–3642.

    Article  CAS  Google Scholar 

  19. Ritz E. Intestinal-renal syndrome: mirage or reality?[J]. Blood Purif. 2011;31:70–76.

    Article  PubMed  Google Scholar 

  20. Flobert C, Cellier C, Berger A, et al. Right colonic involvement is associated with severe forms of ischemic colitis and occurs frequently in patients with chronic renal failure requiring hemodialysis[J]. Am J Gastroenterol. 2000;95:195–198.

    Article  CAS  PubMed  Google Scholar 

  21. Berg RD, Wommack E, Deitch EA. Immunosuppression and intestinal bacterial overgrowth synergistically promote bacterial translocation[J]. Arch Surg. 1988;123:1359–1364.

    Article  CAS  PubMed  Google Scholar 

  22. Navarro JF, Mora C, Leon C, et al. Amino acid losses during hemodialysis with polyacrylonitrile membranes: effect of intradialytic amino acid supplementation on plasma amino acid concentrations and nutritional variables in nondiabetic patients[J]. Am J Clin Nutr. 2000;71:765–773.

    CAS  PubMed  Google Scholar 

  23. Vaziri ND, Yuan J, Rahimi A, et al. Disintegration of colonic epithelial tight junction in uremia: a likely cause of CKD-associated inflammation[J]. Nephrol Dial Transpl. 2012;27:2686–2693.

    Article  CAS  Google Scholar 

  24. Vaziri ND, Yuan J, Nazertehrani S, et al. Chronic kidney disease causes disruption of gastric and small intestinal epithelial tight junction[J]. Am J Nephrol. 2013;38:99–103.

    Article  CAS  PubMed  Google Scholar 

  25. Vaziri ND, Goshtasbi N, Yuan J, et al. Uremic plasma impairs barrier function and depletes the tight junction protein constituents of intestinal epithelium[J]. Am J Nephrol. 2012;36:438–443.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Vaziri ND, Yuan J, Norris K. Role of urea in intestinal barrier dysfunction and disruption of epithelial tight junction in chronic kidney disease[J]. Am J Nephrol. 2012;37:1–6.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Vaziri ND, Yuan J, Khazaeli M, et al. Oral activated charcoal adsorbent (AST-120) ameliorates chronic kidney disease-induced intestinal epithelial barrier disruption[J]. Am J Nephrol. 2013;37:518–525.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Martinez VB, Gonzalez-Juanatey JR. Markers of inflammation and cardiovascular disease: clinical applications of C-reactive protein determination[J]. Am J Cardiovasc Drugs. 2009;9:3–7.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors wish to thank the patients and dialysis staff for their participation. The authors are also grateful to Mr. Shaoli Cheng (Medicine School of Xi’an Jiaotong University, China) in critically revising the manuscript. This work was supported by National Natural Science Foundation of China, No. 30872457.

Conflict of interest

The authors have no conflict of interest to disclose. The results presented in this paper have not been published elsewhere.

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Authors and Affiliations

  1. Dialysis Centre of First Affiliated Hospital of Medicine School, Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an, 710061, Shaanxi, China

    Kehui Shi, Hongli Jiang & Hua Liu

  2. School of Medicine, Xi’an Jiaotong University, Xi’an, Shaanxi, China

    Feiqian Wang, Meng Wei & Zhigang Wang

  3. School of Public Health, Xi’an Jiaotong University, Xi’an, Shaanxi, China

    Li Xie

Authors
  1. Kehui Shi
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  2. Feiqian Wang
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  3. Hongli Jiang
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  4. Hua Liu
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  5. Meng Wei
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  6. Zhigang Wang
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  7. Li Xie
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Corresponding author

Correspondence to Hongli Jiang.

Additional information

Kehui Shi and Feiqian Wang have contributed equally to this work.

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Shi, K., Wang, F., Jiang, H. et al. Gut Bacterial Translocation May Aggravate Microinflammation in Hemodialysis Patients. Dig Dis Sci 59, 2109–2117 (2014). https://doi.org/10.1007/s10620-014-3202-7

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  • DOI: https://doi.org/10.1007/s10620-014-3202-7

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