Do ACE-inhibitors suppress tumour necrosis factor-alpha production in advanced chronic renal failure?

Abstract:

OBJECTIVES:The serum levels of the catabolic cytokine TNF-alpha are often raised in malnourished chronic heart failure patients as well as in chronic renal failure (CRF) patients. Angiotensin-converting enzyme (ACE) inhibitors are often used in these patients and may decrease TNF-alpha and IL-1beta levels in vitro and in vivo. The aim of this study was to find out whether CRF patients with ongoing ACE-inhibitor treatment have lower TNF-alpha levels. DESIGN:Cross-sectional study. SETTING:Tertiary Referral Center and University Hospital. SUBJECTS:Ninety-six predialysis patients (mean age 52 +/- 1 years) with advanced CRF (glomerular filtration rate 7 +/- 1 mL min-1). MAIN OUTCOME MEASURES:Plasma levels of TNF-alpha, subjective global assessment of nutritional status and data on ongoing antihypertensive treatment (ACE-inhibitors, beta blockers, calcium channel blockers and angiotensin II (AII) receptor blockers). RESULTS:Patients treated with ACE-inhibitors (n = 44) had significantly lower plasma TNF-alpha levels (18.5 +/- 1.2 vs. 26.6 +/- 2.2 pg mL-1; P < 0.01) and were less frequently malnourished, relative to 52 patients not treated with ACE-inhibitors. No significant difference in TNF-alpha levels were observed when comparing patients with or without treatment with beta, calcium channel, or AII receptor blockers, respectively. CONCLUSIONS:The present data suggest that the use of ACE-inhibitors is associated with lower plasma TNF-alpha and CRP levels as well as a lower prevalence of malnutrition in patients with advanced CRF. Further studies are needed to establish if there is a casual relationship between these findings and, if so, the molecular mechanism(s).

journal_name

J Intern Med

authors

Stenvinkel P,Andersson P,Wang T,Lindholm B,Bergström J,Palmblad J,Heimbürger O,Cederholm T

doi

10.1046/j.1365-2796.1999.00560.x

subject

Has Abstract

pub_date

1999-11-01 00:00:00

pages

503-7

issue

5

eissn

0954-6820

issn

1365-2796

pii

jim560

journal_volume

246

pub_type

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