Pulmonary dysfunction is possibly a marker of malnutrition and inflammation but not mortality in patients with end-stage renal disease.
BACKGROUND
Various studies have indicated that malnutrition and chronic inflammation are strong predictors of morbidity and mortality in patients with chronic kidney disease (CKD). The purpose of this study was to investigate the relationship between pulmonary function, malnutrition and chronic inflammation in patients with CKD.


METHODS
One hundred and six consenting patients with CKD were enrolled in the study between 2005 and 2007. Pulmonary function was assessed by forced vital capacity (FVC), forced expiratory volume in the first second (FEV(1)) and peak expiratory flow (PEF), expressed as the normal percentage of predicted values (%FEV(1), %FVC and %PEF, respectively). Nutritional status was evaluated by skeletal muscle index (SMI), subjective global nutritional assessment (SGA), lean body mass, body mass index and serum albumin. Inflammation was assessed by the serum measurement of high-sensitive C reactive protein (hsCRP) levels.


RESULTS
Malnutrition (defined as SMI > or =1) and inflammation (defined as hsCRP >2 mg/l) in ESRD patients had significant negative associations with percentage predicted values for pulmonary function tests except %PEF (SMI: %FEV(1), p = 0.009, %FVC, p = 0.001; hsCRP: %FEV(1), p = 0.025, %FVC, p = 0.022). Multivariate Cox analysis showed that the ejection fraction in echocardiography and SGA were associated with poor survival, but there was no association for %FEV(1).


CONCLUSIONS
Impaired pulmonary function was associated with malnutrition and inflammation in these dialysis patients. We were not able to determine a significant relationship between pulmonary function and mortality.
Yoon
Se-Hee
SH
Myunggok Research Institute for Medical Science, Konyang University Hospital, College of Medicine, Konyang University, Daejeon City, Korea.
Choi
Nak-Won
NW
Yun
Sung-Ro
SR
D000328:Adult; D000368:Aged; D001823:Body Composition; D015992:Body Mass Index; D002097:C-Reactive Protein; D002908:Chronic Disease; D016207:Cytokines / Q000378:metabolism; D048909:Diabetes Complications / Q000503:physiopathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007249:Inflammation / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000401:mortality / Q000628:therapy; D008168:Lung / Q000503:physiopathology*; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000473:pathology; D012123:Pulmonary Ventilation; D017582:Renal Replacement Therapy; D012132:Respiratory Muscles / Q000503:physiopathology; D012709:Serum Albumin / Q000032:analysis
D016207:Cytokines; D012709:Serum Albumin; D002097:C-Reactive Protein