title: Kidney insufficiency and nutrient-based modulation of inflammation.
abstract: OBJECTIVE
  Patients with chronic kidney disease have a high cardiovascular mortality rate. Despite recent advances in dialysis techniques, over 20% of US dialysis patients die every year. Protein-energy malnutrition and inflammation are common and usually concurrent in chronic kidney disease patients, and have been implicated as the main cause of high mortality. We reviewed the pathophysiology of the malnutrition-inflammation complex syndrome and its potential modulation by dietary and other nutritional interventions in chronic kidney disease patients.
  
  
  RESULTS
  The malnutrition-inflammation complex syndrome is a main cause of the atherosclerotic cardiovascular disease epidemic in chronic kidney disease. This may be by virtue of the syndrome's inflammatory components. Malnutrition and inflammation lead to weight loss over time, i.e. cachexia in slow motion, and result in decreased serum cholesterol and homocysteine levels. A 'reverse epidemiology' of cardiovascular risk factors is observed in chronic kidney disease, in that obesity, hypercholesterolemia and hyperhomocysteinemia are paradoxically associated with better survival. Among the possible etiologies of the malnutrition-inflammation complex syndrome, anorexia, low nutrient intake and oxidative stress are theoretically amenable to dietary modulation; however, the bulk of findings are epidemiological.
  
  
  CONCLUSIONS
  There is no consensus as to how to correct the malnutrition-inflammation complex syndrome in chronic kidney disease patients. Because the malnutrition-inflammation complex syndrome is multifactorial, its correction probably requires a battery of simultaneous interventions, rather than one single modality. Clinical trials focusing on the syndrome are currently non-existent and are therefore urgently required to improve poor clinical outcome in chronic kidney disease patients.
authors.affiliation: Division of Nephrology and Hypertension, Harbor-UCLA Campus, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA. kamkal@ucla.edu
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
authors.forename: Peter
authors.initials: P
authors.lastname: Stenvinkel
authors.forename: Rachelle
authors.initials: R
authors.lastname: Bross
authors.forename: Osman S
authors.initials: OS
authors.lastname: Khawar
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Rammohan
authors.forename: Sara
authors.initials: S
authors.lastname: Colman
authors.forename: Debbie
authors.initials: D
authors.lastname: Benner
mesh_terms: D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D011502:Protein-Energy Malnutrition / Q000209:etiology / Q000628:therapy*; D006435:Renal Dialysis