Triad of malnutrition, inflammation, and atherosclerosis in hemodialysis patients.
OBJECTIVE
As chronic inflammation underlies both atherosclerosis and malnutrition, a possible link between these factors has been suggested in hemodialysis (HD) patients. We designed this study to compare nutritional indices and inflammatory parameters of HD patients with demonstrated atherosclerosis (group I) and HD patients without (group II).


METHODS
We included 59 and 57 patients in groups I and II, respectively. The patient groups were matched for the risk factors for atherosclerosis such as age, gender, smoking habits, hypertension, and HD duration. The nutritional status of the patients was evaluated according to laboratory parameters, normalized protein catabolic rate, anthropometric measurements, and subjective global assessment.


RESULTS
Laboratory parameters (albumin, prealbumin, total cholesterol, phosphorus, creatinine), normalized protein catabolic rate, and triceps skinfold thickness revealed a significant decline in the nutritional status of the patients with atherosclerosis. We found that the patients with atherosclerosis had significantly higher C-reactive protein, ferritin, and fibrinogen levels when we compared the patient groups for acute-phase reactants. When we assessed malnutrition as being in category B/C (B = mild to moderately malnourished, C = severely malnourished) according to subjective global assessment and inflammation on the basis of a C-reactive protein level > or =10 mg/l, among patients with atherosclerosis, there was a significantly higher proportion of them having malnutrition and inflammation. Additionally, the proportion of patients without any evidence of malnutrition and inflammation was significantly lower in group I than in group II.


CONCLUSIONS
Our study gives evidence for the possible triad of malnutrition, inflammation, and atherosclerosis in HD patients.
Department of Nephrology, Faculty of Medicine, Başkent University, Fevzi Cakmak Bulvarí 10, Sokak No. 45, TR-06490 Bahçelievler, Ankara, Turkey.
Siren
S
Sezer
F Nurhan
FN
Ozdemir
Zübeyde
Z
Arat
Münire
M
Turan
Mehmet
M
Haberal
D000328:Adult; D001161:Arteriosclerosis / Q000503:physiopathology*; D002097:C-Reactive Protein / Q000378:metabolism; D015897:Comorbidity; D005260:Female; D006801:Humans; D007249:Inflammation / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009748:Nutrition Disorders; D009752:Nutritional Status; D006435:Renal Dialysis; D012307:Risk Factors
D002097:C-Reactive Protein