title: The malnutrition-inflammation-depression-arteriosclerosis complex is associated with an increased risk of cardiovascular disease and all-cause death in chronic hemodialysis patients.
abstract: BACKGROUND
  In chronic hemodialysis patients, malnutrition, inflammation, depression and arteriosclerosis are pathogenetically associated suggesting the presence of malnutrition-inflammation-depression-arteriosclerosis (MIDA) complex acting as a risk factor for cardiovascular disease (CVD).
  
  
  METHODS
  Nutritional status was assessed by serum albumin, subjective global assessment and normalized protein catabolic rate (nPCR). Inflammation was assessed by serum high-sensitivity C-reactive protein (hsCRP). Depression was assessed with the Beck Depression Inventory and DSM-IV criteria. The severity of arteriosclerosis was measured by pulse wave velocity (PWV).
  
  
  RESULTS
  Among 81 hemodialysis patients, 44 (54.3%) had malnutrition (albumin <4.0 mg/dl with subjective global assessment score <6 and/or nPCR <1.0) and 39 (48.1%) had inflammation (hsCRP >1 mg/l). The prevalence of depression was 50.6% (n = 41). Fifty-nine (73.8%) had arteriosclerosis (measured PWV > expected PWV based on age/blood pressure/gender adjustment). The severity of the all four individual MIDA components correlated well with each other. The average number of the MIDA complication (MIDA score) was 2.27 ± 1.33. -During the 5-year follow-up, 40 cases of CVD and 26 cases of all-cause death occurred. In Cox analysis adjusted for -previous CVD, age, diabetes, blood pressure, pulse pressure, intradialytic hypotension, B-type natriuretic peptide, -hemoglobin and hemodialysis incompliance, the MIDA score was an independent predictor of CVD and all-cause death: hazard ratio (95% confidence interval); 1.89 (1.13-3.17) and 3.48 (1.32-9.21) for an increase of 1 MIDA score.
  
  
  CONCLUSIONS
  This study suggests the presence of MIDA complex, which is composed of malnutrition, inflammation, depression and arteriosclerosis. The MIDA complex syndrome was an independent risk factor for CVD and all-cause death in chronic hemodialysis patients.
authors.affiliation: Department of Internal Medicine, Hallym University Hospital, Hallym University Kidney Research Institute, Seokwoo-dong, Hwaseong-si, Gyunggi-do, Korea.
authors.forename: Myung-Jin
authors.initials: MJ
authors.lastname: Choi
authors.forename: Jang-Won
authors.initials: JW
authors.lastname: Seo
authors.forename: Jong-Woo
authors.initials: JW
authors.lastname: Yoon
authors.forename: Sang-Kyu
authors.initials: SK
authors.lastname: Lee
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: Young-Ki
authors.initials: YK
authors.lastname: Lee
authors.forename: Jung-Woo
authors.initials: JW
authors.lastname: Noh
authors.forename: Ja-Ryong
authors.initials: JR
authors.lastname: Koo
mesh_terms: D001161:Arteriosclerosis / Q000150:complications*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality*; D002423:Cause of Death; D003863:Depression / Q000150:complications*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications*; D008297:Male; D044342:Malnutrition / Q000150:complications*; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality*; D012307:Risk Factors