What happens to the control mechanism of the inflammatory response when the kidney starts to fail?
Acute renal failure is associated with a high incidence of multiple organ failure (MOF) and death. For example, in cardiac surgery the incidence of acute renal failure requiring dialysis (ARF-D) is 1 5%16 18 Mortality in such circumstances is high, ranging from 28%19 to 63.7%.20 Although this high mortality may be due directly to the deleterious effect on non-renal organs of the precipitating renal insult, there are theoretical possibilities that ARF-D itself has deleterious consequences for other organs by adversely modulating the inflammatory response. If the kidney is so important in controlling inflammatory responses, how can patients in chronic renal failure survive major surgery? During cardiac surgery, the risk of perioperative mortality in patients with preoperative dialysis-dependent chronic renal failure (CRF-D) ranges from zero21 to 11.4%.22 Although preoperative CRF-D may lead to an expectation of greater perioperative morbidity and a longer hospital stay,17 this relatively
