title: Malnutrition and its association with inflammation and vascular disease in children on maintenance dialysis.
abstract: BACKGROUND
  Malnutrition is associated with both inflammation and atherosclerotic cardiovascular disease in adults with chronic kidney disease. We studied the prevalence of malnutrition and its possible associations with inflammation and vascular disease in children on chronic dialysis.
  
  
  METHODS
  Thirty-three patients on maintenance dialysis (18 peritoneal dialysis, 15 hemodialysis) and 19 age- and gender- matched healthy controls were studied. Nutritional status was assessed by anthropometric measurements including body mass index (BMI), upper arm measurements, multifrequency bioimpedance analysis (BIA) and serum levels of albumin, prealbumin, and cholesterol. Inflammation was assessed by serum levels of C-reactive protein (CRP), interleukin (IL)-6, and tumor necrosis factor (TNF)-alpha. The carotid artery intima thickness (cIMT) was measured to assess vascular disease.
  
  
  RESULTS
  Compared with healthy children, patients had lower anthropometric measurements (P < 0.05) and serum albumin level (P < 0.001), and higher CRP and TNF-alpha (P = 0.030 and P = 0.007, respectively), and higher cIMT-SDS (P < 0.001). Malnutrition was present in 8 (24%) and lower BIA-based fat mass was independently associated with higher IL-6 levels (P = 0.035). An increased cIMT was present in 16 (48.5%); however, there was no difference in cIMT-SDS between patients with and without malnutrition. Carotid IMT did not show any association with nutritional indices; but positively correlated with serum IL-6 (P = 0.037), CRP (P = 0.012), and iPTH (P = 0.009), and independently associated with only iPTH (P = 0.018).
  
  
  CONCLUSIONS
  Children on dialysis are at an increased risk of malnutrition, inflammation, and vascular disease. Although each of these three conditions exists, there is no interaction among them all. We postulate that the malnutrition-inflammation-atherosclerosis (MIA) complex might not exist in pediatric dialysis patients.
authors.affiliation: Department of Pediatric Nephrology, Istanbul University Cerrahpasa Faculty of Medicine, 34098, Fatih, Istanbul, Turkey, ncanpolat2000@hotmail.com.
authors.forename: Nur
authors.initials: N
authors.lastname: Canpolat
authors.forename: Salim
authors.initials: S
authors.lastname: Caliskan
authors.forename: Lale
authors.initials: L
authors.lastname: Sever
authors.forename: Mehmet
authors.initials: M
authors.lastname: Tasdemir
authors.forename: Ozlem Balcı
authors.initials: OB
authors.lastname: Ekmekci
authors.forename: Gulseren
authors.initials: G
authors.lastname: Pehlivan
authors.forename: Rukshana
authors.initials: R
authors.lastname: Shroff
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D015415:Biomarkers / Q000097:blood; D001823:Body Composition; D059168:Carotid Intima-Media Thickness; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D017097:Electric Impedance; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications* / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000209:etiology / Q000628:therapy*; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000209:etiology*; D009752:Nutritional Status; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D012885:Skinfold Thickness; D013851:Thinness / Q000453:epidemiology; D014652:Vascular Diseases / Q000150:complications* / Q000209:etiology*; D055815:Young Adult
chemical_list: D015415:Biomarkers