title: Examining associations of circulating endotoxin with nutritional status, inflammation, and mortality in hemodialysis patients.
abstract: OBJECTIVE
  Lipopolysaccharide or endotoxin constitutes most part of the outer portion of the cell wall in the gram-negative bacteria. Subclinical endotoxemia could contribute to increased inflammation and mortality in hemodialysis (HD) patients. Endotoxin level and clinical effect are determined by its soluble receptor sCD14 and high-density lipoprotein. We examine the hypothesis that endotoxin level correlates with mortality.
  
  
  METHODS
  In this cohort study, endotoxin levels were measured in 306 long-term HD patients who were then followed up for a maximum of 42 months. Soluble CD14 and cytokines levels were also measured.
  
  
  RESULTS
  The mean (±SD) endotoxin level was 2.31 ± 3.10 EU/mL (minimum: 0.26 EU/mL, maximum: 22.94 EU/mL, interquartile range: 1.33 EU/mL, median: 1.27 EU/mL). Endotoxin correlated with C-reactive protein (r = 0.11, P < .04). On multivariate logistic regression analysis, high body mass index and low high-density lipoprotein (HDL) cholesterol levels were associated with higher endotoxemia (endotoxin below or above of median). In multivariate Cox regression analysis adjusted for case-mix and nutritional/inflammatory confounders, endotoxin levels in the third quartile versus first quartile were associated with a trend toward increased hazard ratio for death (hazard ratio: 1.83, 95% confidence interval: 0.93 to 3.6, P = .08).
  
  
  CONCLUSIONS
  In this HD cohort, we found associations between endotoxemia and C-reactive protein, body composition, and HDL. Moderately high endotoxin levels tended to correlate with increased mortality than the highest circulating endotoxin level. Additional studies are required to assess the effect of endotoxemia on mortality in dialysis population.
authors: Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA. kamkal@ucla.edu
authors: Usama
authors: U
authors: Feroze
authors: Kamyar
authors: K
authors: Kalantar-Zadeh
authors: Kevin A
authors: KA
authors: Sterling
authors: Miklos Z
authors: MZ
authors: Molnar
authors: Nazanin
authors: N
authors: Noori
authors: Debbie
authors: D
authors: Benner
authors: Vallabh
authors: V
authors: Shah
authors: Rama
authors: R
authors: Dwivedi
authors: Kenneth
authors: K
authors: Becker
authors: Csaba P
authors: CP
authors: Kovesdy
authors: Dominic S
authors: DS
authors: Raj
mesh_terms: D000328:Adult; D000368:Aged; D001775:Blood Circulation / Q000187:drug effects; D001823:Body Composition; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis / Q000378:metabolism; D015331:Cohort Studies; D019446:Endotoxemia / Q000150:complications / Q000401:mortality; D004731:Endotoxins / Q000097:blood*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000503:physiopathology*; D008075:Lipoproteins, HDL / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009752:Nutritional Status; D011502:Protein-Energy Malnutrition / Q000150:complications / Q000401:mortality*; D006435:Renal Dialysis / Q000401:mortality*
chemical_list: D004731:Endotoxins; D008075:Lipoproteins, HDL; D002097:C-Reactive Protein