Could we reduce the prevalence of inflammation among patients with chronic kidney disease?

patients with more advanced renal failure. However, as detected in previous studies [5–7] , CRP levels were not normally distributed, suggesting the presence of a mixed population of different subgroups of patients: patients with high and patients with normal CRP values despite a similar creatinine clearance. The results suggest that reduced renal function by itself could not be fully responsible of the infl ammatory response. It seems that other factors, frequently associated with renal failure and which can worsen with the worsening of renal function, may contribute to activate the infl ammatory response. Ates et al. [8] also analyzed echocardiographic data in their patients. They found a strong direct correlation between CRP levels and left-ventricular mass index (LVMi) and between CRP and fractional shortening, suggesting an association between infl ammation and left-ventricular hypertrophy or dysfunction. The authors conclude that serum CRP is an independent factor affecting CV disease and that infl ammation may play a key role in the pathogenesis of left-ventricular abnormalities. Nevertheless, the interpretation of these interesting results could be different. Our group has recently found a strong association between CRP and N-terminal pro-Btype natriuretic peptide (N-BNP) values in patients with advanced renal failure [9] . B-type natriuretic peptide (BNP) is a cardiac neurohormone specifi cally secreted Chronic renal failure is associated with a signifi cantly increased risk for cardio-vascular (CV) disease and for CV-related mortality [1] . Among the non-traditional risk factors for the development of CV disease in patients with chronic kidney disease (CKD), chronic infl ammation deserves special attention. The prevalence of infl ammation among patients with CKD is high and several studies have shown that infl ammation is a powerful predictor of mortality in dialysis patients, mainly due to cardiovascular events [2–4] . An activated infl ammatory response is frequently detected also in patients with CKD prior to initiation of dialysis [5–7] . The mechanisms underlying an activated acute-phase response in pre-dialysis patients are not yet fully understood. A decreased renal clearance of pro-infl ammatory cytokines or C-reactive protein (CRP) has been suggested by some authors [7] , as they found a negative correlation between serum CRP and creatinine clearance in patients with a wide range of renal insuffi ciency. In this issue of Nephron Clinical Practice , Ates et al. [8] analyze the prevalence of elevated serum CRP in patients with different stages of chronic renal insuffi ciency. They have found a strong negative correlation between CRP levels and creatinine clearance. The prevalence of elevated serum CRP was increased in the subgroup of Published online: August 9, 2005