title: ["Malnutrition-inflammation complex syndrome" in chronic hemodialysis].
abstract: Protein-energy wasting (PEW) and inflammation are usually common and concurrent conditions in maintenance dialysis patients and associated with poor prognosis. Low appetite and hypercatabolic states are common features. In dialysis patients, the former has been suggested to be secondary to inflammation; however, the evidence is not conclusive. Hence, the term malnutrition-inflammation complex syndrome (MICS) was coined to include this clinical entity, regardless the original causes. Possible causes of MICS include comorbid illnesses, oxidative stress, nutrient loss through dialysis, hyporexia, uremic toxins, decreased clearance of inflammatory cytokines, volume overload, increased blood phosphate and dialysis-related factors. MICS is believed to be the main cause of erythropoietin hypo-responsiveness, cardiovascular atherosclerotic disease, decreased quality of life, hospitalization and increased mortality in dialysis patients. Because MICS leads to a low body mass index, hypocholesterolemia, decrease in muscle mass, hypocreatininemia and hypohomocysteinemia, a "reverse epidemiology" phenomenon of cardiovascular risk factors can occur in dialysis patients. Therefore, obesity, hypercholesterolemia, and increased blood levels of creatinine and homocysteine, within certain limits, appear to be protective and paradoxically associated with a better outcome. There is no consensus about how to determine the degree of severity of MICS or how to manage it. Several diagnostic tools and treatment modalities are discussed in this paper. The correct management of MICS may diminish the cardiovascular disease, main cause of death in this population.
authors.affiliation: Servicio de Clínica Médica, Hospital Británico de Buenos Aires. pabloyoung2003@yahoo.com.ar
authors.forename: Pablo
authors.initials: P
authors.lastname: Young
authors.forename: Fernando
authors.initials: F
authors.lastname: Lombi
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Finn
authors.forename: Mariano
authors.initials: M
authors.lastname: Forrester
authors.forename: Vicente
authors.initials: V
authors.lastname: Campolo-Girard
authors.forename: Vanesa
authors.initials: V
authors.lastname: Pomeranz
authors.forename: Romina
authors.initials: R
authors.lastname: Iriarte
authors.forename: Julio E
authors.initials: JE
authors.lastname: Bruetman
authors.forename: Hernan
authors.initials: H
authors.lastname: Trimarchi
mesh_terms: D006801:Humans; D007249:Inflammation / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D011502:Protein-Energy Malnutrition / Q000209:etiology*; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D013577:Syndrome