Clinical value of the malnutrition-inflammation-atherosclerosis syndrome for long-term prediction of cardiovascular mortality in patients with end-stage renal disease: a 5-year prospective study.
OBJECTIVE
Mortality resulting from cardiovascular disease in patients with end-stage renal disease (ESRD) is high. In this study we sought to investigate the clinical value of the malnutrition-inflammation-atherosclerosis (MIA) syndrome for long-term prediction of cardiovascular mortality in patients treated with ESRD.


METHODS
A total of 42 ESRD patients on hemodialysis were enrolled. Inflammatory markers and nutritional parameters were determined. Carotid atherosclerosis was investigated by ultrasonographically evaluated carotid intima-media thickness (cIMT). Mortality was evaluated at a 5-year follow-up.


RESULTS
No correlation was evident between nutritional markers and inflammatory indexes. cIMT was inversely correlated with predialysis serum albumin. In the overall population of 42 patients, 11 (26.2%) died of cardiovascular causes during follow-up. Kaplan-Meier survival curves indicate that cIMT (> or =0.9 mm), C-reactive protein (CRP) (>1 mg/dl), and serum albumin (<3.5 g/dl) predict cardiovascular death in patients with ESRD.


CONCLUSIONS
We have demonstrated that cIMT, CRP and serum albumin predict long-term mortality in ERSD patients. Our study suggests that further investigation of the MIA syndrome will provide insights into the susceptibility to CVD in this patient group.
Akdag
Ibrahim
I
Department of Nephrology and Rheumatology, Uludag University Medical School, Bursa, Turkey. akdagi@uludag.edu.tr
Yilmaz
Yusuf
Y
Kahvecioglu
Serdar
S
Bolca
Naile
N
Ercan
Ilker
I
Ersoy
Alpaslan
A
Gullulu
Mustafa
M
D000328:Adult; D000368:Aged; D000886:Anthropometry; D050197:Atherosclerosis / Q000150:complications*; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications*; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000401:mortality; D008297:Male; D044342:Malnutrition / Q000150:complications*; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D018709:Statistics, Nonparametric; D013577:Syndrome; D014463:Ultrasonography
D012709:Serum Albumin; D002097:C-Reactive Protein