title: Nonalcoholic fatty liver disease (NAFLD) - a new factor that interplays between inflammation, malnutrition, and atherosclerosis in elderly hemodialysis patients.
abstract: OBJECTIVE
  In the past decade, in most regions of the world, an increasing number of adults aged 65 years and older were started on renal replacement therapy each year. In contrast to the general population for whom overnutrition or obesity is associated with increased cardiovascular risk, for patients who are maintained on hemodialysis (HD), malnutrition and malnutrition-inflammation complex syndrome are associated with poor outcome. In recent years, nonalcoholic fatty liver disease (NAFLD) has been considered to be the liver manifestation of metabolic syndrome, and the development of NAFLD is strongly associated with all components of metabolic syndrome (arterial hypertension, dyslipidemia, obesity, and diabetes mellitus type 2) in the general population. The primary end point of this study was to determine the patient's survival in relation to nutritional and inflammatory state and the presence or absence of NAFLD. The secondary end point of this analysis was the association among NAFLD and various clinical and laboratory data, with the nutritional and inflammatory state of our elderly HD patients.
  
  
  METHODS
  Using a single-center, prospective, cohort study design, we followed the progress of 76 patients who were ≥ 65 years and treated with chronic HD for at least 6 months, at the Department of Nephrology, Dialysis and Transplantation. All patients were followed for a minimum of 18 months or until death. Survival was defined as the time from study initiation to death (or end of study, if still alive).
  
  
  RESULTS
  The main findings of our study were a remarkable positive correlation between NAFLD and high-sensitivity C-reactive protein (hs-CRP) (r=0.659; P<0.0001) and consequent negative correlation with the nutritional parameter, serum albumin (r=-0.321; P=0.004). Interestingly, we showed that in contrast to the general population, where NAFLD is associated with obesity, in the present study, there was no statistically significant association between NAFLD and overnutrition in elderly HD patients. Furthermore, the presence of NAFLD, low serum albumin levels, and high hs-CRP were strong predictors of poor outcome in our elderly HD patients.
  
  
  CONCLUSIONS
  Our results indicated that NAFLD probably interplays between inflammation, malnutrition, and atherosclerosis in elderly HD patients. NAFLD could be a new factor that contributes to type 2 malnutrition in elderly HD patients, who may be amenable to adequate nutritional and HD support.
authors.affiliation: Department of Nephrology, Dialysis and Transplantation, Rijeka University Hospital Center, Rijeka, Croatia.
authors.forename: Ivana
authors.initials: I
authors.lastname: Mikolasevic
authors.affiliation: Department of Internal Medicine, Dr Josip Bencevic General Hospital, Slavonski Brod, Croatia.
authors.forename: Vesna
authors.initials: V
authors.lastname: Lukenda
authors.affiliation: Department of Nephrology, Dialysis and Transplantation, Rijeka University Hospital Center, Rijeka, Croatia.
authors.forename: Sanjin
authors.initials: S
authors.lastname: Racki
authors.affiliation: Department of Gastroenterology, Rijeka University Hospital Center, Rijeka, Croatia.
authors.forename: Sandra
authors.initials: S
authors.lastname: Milic
authors.affiliation: Department of Nephrology, Dialysis and Transplantation, Rijeka University Hospital Center, Rijeka, Croatia.
authors.forename: Branka
authors.initials: B
authors.lastname: Sladoje-Martinovic
authors.affiliation: Department of Nephrology, Dialysis and Transplantation, Rijeka University Hospital Center, Rijeka, Croatia.
authors.forename: Lidija
authors.initials: L
authors.lastname: Orlic
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000209:etiology*; D002097:C-Reactive Protein / Q000032:analysis; D017523:Croatia; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007249:Inflammation / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy*; D008297:Male; D044342:Malnutrition / Q000209:etiology*; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications*; D011446:Prospective Studies; D006435:Renal Dialysis; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D015996:Survival Rate
chemical_list: D012709:Serum Albumin; D002097:C-Reactive Protein
keywords: cardiovascular risk; high-sensitivity C-reactive protein (hs-CRP); serum albumin