Figure 1.

During chronic kidney disease (CKD), increases (↑) in adipokines and in adhesion proteins (such as ICAM-1 and VCAM-1) are observed. Uremic toxins play a very important role in the onset and progression of the inflammatory state, by increasing C-reactive protein (CRP), nitric oxide (NO) and a marked activation of the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), which lead to increased levels of pro-inflammatory cytokines, such as interleukin-6 and -1 (IL-6, IL-1). These also suppress (↓) parathyroid hormone (PTH) secretion, as well as enhancing the levels of tumor necrosis factor-α (TNF-α) and pro-inflammatory enzymes and molecules. This process leads to an exacerbation of the inflammatory state and is responsible for the onset or aggravation of various complications, such as malnutrition, atherosclerosis, coronary artery calcification, heart failure, anemia and mineral disorders.