title: Relationship between plasma levels of zonulin, bacterial lipopolysaccharides, D-lactate and markers of inflammation in haemodialysis patients.
abstract: BACKGROUND
  Increased permeability of the intestinal wall and intestinal dysbiosis may contribute to chronic systemic inflammation, one of the causes of accelerated atherosclerosis and cardiovascular morbidity and mortality burden in patients with chronic kidney disease. The aim of this study was to evaluate the association between markers of intestinal permeability and inflammation in haemodialysis (HD) patients.
  
  
  METHODS
  Plasma concentration of zonulin, haptoglobin, TNFα, IL6, D-lactates and bacterial lipopolysaccharides (LPS) was assessed in blood samples obtained after overnight fast before midweek morning HD session in 150 stable, prevalent HD patients. Daily intake of energy and macronutrients was assessed on the basis of a food frequency questionnaire.
  
  
  RESULTS
  Serum hsCRP level was increased in over 70% of patients. Plasma levels of zonulin [11.6 (10.9-12.3) vs 6.8 (5.8-7.8) ng/mL], IL6 [6.2 (1.0-10.3) vs 1.3 (1.0-2.0) pg/mL] and TNFα [5.9 (2.9-11.8) vs 1.6 (1.3-1.8) pg/mL], but not LPS and D-lactates were significantly higher in HD than in healthy controls. D-lactates and LPS levels were weakly associated with IL6 (R = 0.175; p = 0.03, and R = 0.241; p = 0.003). There was a borderline correlation between plasma zonulin and serum hsCRP (R = 0.159; p = 0.07), but not with IL6, LPS and D-lactates. In multiple regression, both serum CRP and plasma IL6 variability were explained by LPS (β = 0.143; p = 0.08 and β = 0.171; p = 0.04, respectively), only.
  
  
  CONCLUSIONS
  The weak association between plasma D-lactate, LPS and IL6 levels indicates that intestinal flora overgrowth or increased intestinal permeability contributes very slightly to the chronic inflammation development in HD patients.
authors.affiliation: Pathophysiology Unit, Department of Pathophysiology, School of Medicine in Katowice, Medical University of Silesia, Medyków 18 Street, 40-752, Katowice, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Ficek
authors.affiliation: Health Promotion and Obesity Management Unit, Department of Pathophysiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Wyskida
authors.affiliation: Department of Nephrology, Transplantation and Internal Medicine, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
authors.forename: Rafał
authors.initials: R
authors.lastname: Ficek
authors.affiliation: Dialysis Center in Rybnik, Regional Specialist Hospital No. 3 in Rybnik, Rybnik, Poland.
authors.forename: Jarosław
authors.initials: J
authors.lastname: Wajda
authors.affiliation: Dialysis Center in Tychy, Centrum Dializa Sosnowiec, Tychy, Poland.|Dialysis Center in Pszczyna, Centrum Dializa Sosnowiec, Pszczyna, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Klein
authors.affiliation: Dialysis Center in Siemianowice Śląskie, Nefrolux, Siemianowice Śląskie, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Witkowicz
authors.affiliation: Dialysis Center in Katowice, Centrum Dializa Sosnowiec, Katowice, Poland.
authors.forename: Sylwia
authors.initials: S
authors.lastname: Rotkegel
authors.affiliation: Dialysis Center in Chorzów, Centrum Dializa Sosnowiec, Chorzów, Poland.
authors.forename: Urszula
authors.initials: U
authors.lastname: Spiechowicz-Zatoń
authors.affiliation: Dialysis Center in Żory, Centrum Dializa Sosnowiec, Żory, Poland.|Dialysis Center in Wodzisław Śląski, Centrum Dializa Sosnowiec, Wodzisław Śląski, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Kocemba-Dyczek
authors.affiliation: Dialysis Center in Sosnowiec, Centrum Dializa Sosnowiec, Sosnowiec, Poland.
authors.forename: Jarosław
authors.initials: J
authors.lastname: Ciepał
authors.affiliation: Department of Nephrology, Transplantation and Internal Medicine, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Więcek
authors.affiliation: Health Promotion and Obesity Management Unit, Department of Pathophysiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Olszanecka-Glinianowicz
authors.affiliation: Pathophysiology Unit, Department of Pathophysiology, School of Medicine in Katowice, Medical University of Silesia, Medyków 18 Street, 40-752, Katowice, Poland. chj@poczta.fm.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Chudek
mesh_terms: D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002772:Cholera Toxin / Q000097:blood; D005260:Female; D006242:Haptoglobins / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000209:etiology*; D015850:Interleukin-6 / Q000097:blood; D007413:Intestinal Mucosa / Q000378:metabolism*; D019344:Lactic Acid / Q000097:blood; D008070:Lipopolysaccharides / Q000097:blood; D008297:Male; D008875:Middle Aged; D010539:Permeability; D011498:Protein Precursors; D006435:Renal Dialysis / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000628:therapy; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015415:Biomarkers; D006242:Haptoglobins; D015850:Interleukin-6; D008070:Lipopolysaccharides; D011498:Protein Precursors; D014409:Tumor Necrosis Factor-alpha; C408043:zonulin; D019344:Lactic Acid; D002097:C-Reactive Protein; D002772:Cholera Toxin
keywords: Chronic renal failure; D-Lactate; Haemodialysis; Inflammation; Intestinal permeability; Zonulin