title: Comparison of nutritional and inflammatory markers in dialysis patients with reduced appetite.
abstract: BACKGROUND
  Anorexia is common in chronic kidney disease and worsens as the disease progresses. Sex hormones and inflammatory cytokines may be related to feeding behavior.
  
  
  OBJECTIVE
  We hypothesized that appetite would be related to inflammation and outcome in hemodialysis patients but that sex may account for differences in the symptoms associated with poor appetite.
  
  
  METHODS
  A cross-sectional study was conducted in patients undergoing prevalent hemodialysis (n = 223; 127 M; x +/- SD age: 66 +/- 14 y). Anthropometric markers of body composition, handgrip strength, and nutritional and inflammatory status were measured, and 3 groups according to their self-reported appetite were established. Overall mortality was assessed after 19 mo (range: 2-29 mo) of follow-up.
  
  
  RESULTS
  Poor appetite was associated with a longer vintage time, increased inflammation (higher serum concentrations of interleukin 6 and C-reactive protein), and a worse nutritional status (lower serum concentrations of insulin-like growth factor I, albumin, urea, and creatinine). However, across worsening appetite scale, handgrip strength was incrementally lower in men but not in women (multivariate analysis of variance). In a multivariate logistic regression analysis (pseudo r(2) = 0.19), appetite loss was associated with sex [odds ratio (OR): 0.41; 95% CI: 0.24, 0.72], insulin-like growth factor I (3.58; 2.10, 6.32), and C-reactive protein > 10 mg/L (2.39; 1.34, 4.11). Finally, appetite loss was associated with worse clinical outcome even after adjustment for age, sex, inflammation, dialysis vintage, and comorbidity (likelihood ratio = 44.3; P < 0.0001).
  
  
  CONCLUSIONS
  These results show a close association among appetite, malnutrition, inflammation, and outcome in patients undergoing prevalent hemodialysis. Moreover, our data suggest that uremic men may be more susceptible than are women to inflammation-induced anorexia.
authors.affiliation: Division of Renal, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Karolinska University Hospital at Huddinge, Stockholm, Sweden.
authors.forename: Juan Jesús
authors.initials: JJ
authors.lastname: Carrero
authors.forename: Abdul Rashid
authors.initials: AR
authors.lastname: Qureshi
authors.forename: Jonas
authors.initials: J
authors.lastname: Axelsson
authors.forename: Carla María
authors.initials: CM
authors.lastname: Avesani
authors.forename: Mohammed E
authors.initials: ME
authors.lastname: Suliman
authors.forename: Sawako
authors.initials: S
authors.lastname: Kato
authors.forename: Peter
authors.initials: P
authors.lastname: Bárány
authors.forename: Sunna
authors.initials: S
authors.lastname: Snaedal-Jonsdottir
authors.forename: Anders
authors.initials: A
authors.lastname: Alvestrand
authors.forename: Olof
authors.initials: O
authors.lastname: Heimbürger
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindholm
authors.forename: Peter
authors.initials: P
authors.lastname: Stenvinkel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001066:Appetite; D015415:Biomarkers / Q000097:blood; D001823:Body Composition; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis; D003430:Cross-Sectional Studies; D018737:Hand Strength; D006801:Humans; D007249:Inflammation / Q000503:physiopathology*; D008875:Middle Aged; D009752:Nutritional Status; D006435:Renal Dialysis / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein