Infectious Disease Risk in Dialysis Patients: A Transdisciplinary Approach
Purpose of review: Infections are a major contributor to morbidity and mortality in end-stage renal disease (ESRD) patients. A better understanding of the interplay between infectious processes and ESRD may eventually lead to the development of targeted treatment strategies aimed at lowering overall...
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Online Access: | https://doi.org/10.1177/2054358119839080 |
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doaj-4127b6bc2216457189e4fec2f8c0e2922020-11-25T03:43:01ZengSAGE PublishingCanadian Journal of Kidney Health and Disease2054-35812019-04-01610.1177/2054358119839080Infectious Disease Risk in Dialysis Patients: A Transdisciplinary ApproachCaroline Lamarche0Ioan-Andrei Iliuta1Thomas Kitzler2BC Children’s Hospital Research Institute, Vancouver, CanadaUniversity Health Network, Toronto, ON, CanadaBoston Children’s Hospital, MA, USAPurpose of review: Infections are a major contributor to morbidity and mortality in end-stage renal disease (ESRD) patients. A better understanding of the interplay between infectious processes and ESRD may eventually lead to the development of targeted treatment strategies aimed at lowering overall disease morbidity and mortality. Monogenic causes are a major contributor to the development of adult chronic kidney disease (CKD). Recent studies identified a genetic cause in 10% to 20% of adults with CKD. With the introduction of whole-exome sequencing (WES) into clinical mainstay, this proportion is expected to increase in the future. Once patients develop CKD/ESRD due to a genetic cause, secondary changes, such as a compromised immune status, affect overall disease progression and clinical outcomes. Stratification according to genotype may enable us to study its effects on secondary disease outcomes, such as infectious risk. Moreover, this knowledge will enable us to better understand the molecular interplay between primary disease and secondary disease outcomes. Sources of information: We conducted a literature review using search engines such as PubMed, PubMed central, and Medline, as well as cumulative knowledge from our respective areas of expertise. Methods: This is a transdisciplinary perspective on infectious complications in ESRD due to monogenic causes, such as autosomal dominant polycystic kidney disease (ADPKD), combining expertise in genomics and immunology. Key findings: In ADPKD, infection is a frequent complication manifesting primarily as lower urinary tract infection and less frequently as renal infection. Infectious episodes may be a direct consequence of a specific underlying structural abnormality, for example the characteristic cysts, among others. However, evidence suggests that infectious disease risk is also increased in ESRD due to secondary not-well-understood disease mechanisms. These disease mechanisms may vary depending on the underlying nature of the primary disease. While the infectious disease risk is well documented in ADPKD, there are currently insufficient data on the risk in other monogenic causes of ESRD. WES in combination with novel technologies, such as RNA sequencing and single-cell RNA sequencing, can provide insight into the molecular mechanisms of disease progression in different monogenic causes of CKD/ESRD and may lead to the development of novel risk-stratification profiles in the future. Limitations: This is not a systematic review of the literature and the proposed perspective is tainted by the authors’ point of view on the topic. Implications: WES in combination with novel technologies such as RNA sequencing may enable us to fully unravel underlying disease mechanisms and secondary disease outcomes in monogenic causes of CKD and better characterize individual risk profiles. This understanding will hopefully facilitate the development of novel targeted therapies.https://doi.org/10.1177/2054358119839080 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Caroline Lamarche Ioan-Andrei Iliuta Thomas Kitzler |
spellingShingle |
Caroline Lamarche Ioan-Andrei Iliuta Thomas Kitzler Infectious Disease Risk in Dialysis Patients: A Transdisciplinary Approach Canadian Journal of Kidney Health and Disease |
author_facet |
Caroline Lamarche Ioan-Andrei Iliuta Thomas Kitzler |
author_sort |
Caroline Lamarche |
title |
Infectious Disease Risk in Dialysis Patients: A Transdisciplinary Approach |
title_short |
Infectious Disease Risk in Dialysis Patients: A Transdisciplinary Approach |
title_full |
Infectious Disease Risk in Dialysis Patients: A Transdisciplinary Approach |
title_fullStr |
Infectious Disease Risk in Dialysis Patients: A Transdisciplinary Approach |
title_full_unstemmed |
Infectious Disease Risk in Dialysis Patients: A Transdisciplinary Approach |
title_sort |
infectious disease risk in dialysis patients: a transdisciplinary approach |
publisher |
SAGE Publishing |
series |
Canadian Journal of Kidney Health and Disease |
issn |
2054-3581 |
publishDate |
2019-04-01 |
description |
Purpose of review: Infections are a major contributor to morbidity and mortality in end-stage renal disease (ESRD) patients. A better understanding of the interplay between infectious processes and ESRD may eventually lead to the development of targeted treatment strategies aimed at lowering overall disease morbidity and mortality. Monogenic causes are a major contributor to the development of adult chronic kidney disease (CKD). Recent studies identified a genetic cause in 10% to 20% of adults with CKD. With the introduction of whole-exome sequencing (WES) into clinical mainstay, this proportion is expected to increase in the future. Once patients develop CKD/ESRD due to a genetic cause, secondary changes, such as a compromised immune status, affect overall disease progression and clinical outcomes. Stratification according to genotype may enable us to study its effects on secondary disease outcomes, such as infectious risk. Moreover, this knowledge will enable us to better understand the molecular interplay between primary disease and secondary disease outcomes. Sources of information: We conducted a literature review using search engines such as PubMed, PubMed central, and Medline, as well as cumulative knowledge from our respective areas of expertise. Methods: This is a transdisciplinary perspective on infectious complications in ESRD due to monogenic causes, such as autosomal dominant polycystic kidney disease (ADPKD), combining expertise in genomics and immunology. Key findings: In ADPKD, infection is a frequent complication manifesting primarily as lower urinary tract infection and less frequently as renal infection. Infectious episodes may be a direct consequence of a specific underlying structural abnormality, for example the characteristic cysts, among others. However, evidence suggests that infectious disease risk is also increased in ESRD due to secondary not-well-understood disease mechanisms. These disease mechanisms may vary depending on the underlying nature of the primary disease. While the infectious disease risk is well documented in ADPKD, there are currently insufficient data on the risk in other monogenic causes of ESRD. WES in combination with novel technologies, such as RNA sequencing and single-cell RNA sequencing, can provide insight into the molecular mechanisms of disease progression in different monogenic causes of CKD/ESRD and may lead to the development of novel risk-stratification profiles in the future. Limitations: This is not a systematic review of the literature and the proposed perspective is tainted by the authors’ point of view on the topic. Implications: WES in combination with novel technologies such as RNA sequencing may enable us to fully unravel underlying disease mechanisms and secondary disease outcomes in monogenic causes of CKD and better characterize individual risk profiles. This understanding will hopefully facilitate the development of novel targeted therapies. |
url |
https://doi.org/10.1177/2054358119839080 |
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AT carolinelamarche infectiousdiseaseriskindialysispatientsatransdisciplinaryapproach AT ioanandreiiliuta infectiousdiseaseriskindialysispatientsatransdisciplinaryapproach AT thomaskitzler infectiousdiseaseriskindialysispatientsatransdisciplinaryapproach |
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