title: Association between novel indices of malnutrition-inflammation complex syndrome and cardiovascular disease in hemodialysis patients.
abstract: BACKGROUND
  Inflammation and malnutrition are recognized as important risk factors for cardiovascular disease (CVD) in hemodialysis (HD) patients. Owing to substantial short-term variability of serum C-reactive protein (CRP), more reliable markers of malnutrition-inflammation complex syndrome should be sought with stronger associations with the risk of CVD in HD patients. We therefore explored the clinical relevance of a composite inflammatory index (prognostic inflammatory and nutritional index [PINI]) and of muscle protein mass indicators, derived from creatinine kinetics.
  
  
  METHODS
  This cross-sectional study included 177 HD patients (89 women and 88 men; median age, 67.73 years). CVD and risk factors were assessed using medical charts, clinical examination, and biochemical measurements performed at inclusion. Lean body mass (LBM) was derived from creatinine kinetic modeling, whereas PINI was calculated as the ratio (CRP xalpha1-acid-glycoprotein)/(albumin x transthyretin). Patients were divided according to the presence or absence of established CVD.
  
  
  RESULTS
  The traditional risk factors diabetes (odds ratio [OR], 5.83; p = 0.0045) and smoking (OR, 3.50; p < 0.02) were associated with an increase in prevalent CVD. Low transthyretin (OR, 3.79; p < 0.02) and high levels of CRP (OR, 2.70; p < 0.05), PINI (OR, 3.44; p < 0.02), observed LBM (OR, 3.01; p < 0.05), and the ratio of observed/expected LBM (OR, 4.24; p < 0.01) were associated with CVD after adjustment for age, sex, dialysis center, and dialysis vintage. After additional adjustment for diabetes and smoking, only PINI (OR, 2.85; p = 0.0446) and observed/expected LBM (OR, 2.96; p = 0.0361) were still significant.
  
  
  CONCLUSIONS
  PINI and LBM are associated with increased relative risk for having CVD and could be used routinely to examine the degree of severity of malnutrition inflammation complex syndrome.
authors.affiliation: Biochemistry Laboratory, Centre Hospitalier Universitaire de Montpellier, Montpellier, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Terrier
authors.forename: Lynne
authors.initials: L
authors.lastname: Senécal
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Dupuy
authors.forename: Isabelle
authors.initials: I
authors.lastname: Jaussent
authors.forename: Cécile
authors.initials: C
authors.lastname: Delcourt
authors.forename: Hélène
authors.initials: H
authors.lastname: Leray
authors.forename: Silje
authors.initials: S
authors.lastname: Rafaelsen
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Bosc
authors.forename: François
authors.initials: F
authors.lastname: Maurice
authors.forename: Bernard
authors.initials: B
authors.lastname: Canaud
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Cristol
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000097:blood / Q000209:etiology*; D015415:Biomarkers; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000209:etiology*; D008875:Middle Aged; D009752:Nutritional Status; D006435:Renal Dialysis / Q000009:adverse effects; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers