title: Validation of the high mortality rate of Malnutrition-Inflammation-Atherosclerosis syndrome: -Community-based observational study.
abstract: BACKGROUND
  Malnutrition-Inflammation-Atherosclerosis (MIA) factors significantly and independently affect life prognosis of hemodialysis (HD) patients. We re-evaluated Japanese data, which have progressed ahead from a community-based observational study. The present study was designed to assess the contribution of these MIA factors to the mortality rate of Japanese HD patients in a community of 1.8 million people over a 36-month follow-up period.
  
  
  RESULTS
  A total of 5813 patients at 76 facilities were on maintenance HD in the Kumamoto Prefecture. Specifically, 4807 of these patients at 58 institutions were enrolled. Patients who exhibited lower serum albumin and higher serum C-reactive protein levels were defined as "malnourished" and "inflamed", respectively, compared with the median values. Patients who underwent invasive procedures for atherosclerotic diseases were defined as "atherosclerotic". The 36-month all-cause mortality rate in Japanese HD patients was 12.4%. This rate directly correlated with the number of MIA factors. The odds ratio of the all-cause mortality rate markedly and significantly increased as the number of factors increased. The presence of 3 MIA factors in HD patients was a significant predictor of mortality, as evidenced by a multivariate logistic regression analysis.
  
  
  CONCLUSIONS
  This study clearly demonstrated the close association between MIA syndrome and high mortality in Japanese HD patients. Early detection and the adjustment of MIA factors are mandatory.
authors.affiliation: Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Sueta
authors.affiliation: Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan. Electronic address: shokimot@kumamoto-u.ac.jp.
authors.forename: Seiji
authors.initials: S
authors.lastname: Hokimoto
authors.affiliation: Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Sakamoto
authors.affiliation: Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Akasaka
authors.affiliation: Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Tabata
authors.affiliation: Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Kaikita
authors.affiliation: Committee of Dialysis Facilities in Kumamoto, Kumamoto, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Honda
authors.affiliation: Committee of Dialysis Facilities in Kumamoto, Kumamoto, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Naruse
authors.affiliation: Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D007564:Japan; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality* / Q000628:therapy; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D008875:Middle Aged; D006435:Renal Dialysis; D015203:Reproducibility of Results; D015996:Survival Rate; D013577:Syndrome
keywords: End-stage renal disease; Hemodialysis; MIA syndrome