Background: Mortality resulting from cardiovascular disease in patients with end-stage renal disease (ESRD) is high. In this study we study characteristics of the malnutrition, inflammation, atherosclerosis (MIA) syndrome; relationship between MIA syndrome and the cardiovascular events in hemodialysis patients. Subjects and methods: A total of 61 hemodialysis patients were enrolled. Inflammatory marker (hs CRP) and nutritional parameters (albumin, prealbumin, BMI) were determined. Carotid atherosclerosis was investigated by ultrasonographically evaluated carotid intima-media thickness (cIMT). Results: -The characteristics of the malnutrition, inflammation, atherosclerosis(MIA) syndrome in in peritoneal dialysis patients: + MIA2-3 group had an average age lower than MIA0 group + MIA2-3 group had lower albumin levels and BMI than MIA0 group. + The prevalence of malnutrition (50.8%), inflammation (27.9%), and atherosclerosis (52.5%); 24 (39.3%) of the patients had one risk factor; 22 (36.1%) of the patients had two risk factors; 4 (6.6%) of the patients had all three risk factors. No signs of either malnutrition, inflammation or atherosclerosis were seen in 11 (18.0%) of patients. Note that a considerable number of patients with malnutrition (23/31 patients) had signs of inflammation or atherosclerosis or both; 12/32 patients with atherosclerosis had signs of inflammation or malnutrition or both. - The relationship between MIA syndrome and the cardiovascular events in peritoneal dialysis patients: We have found the relationship between component M (malnutrition) and the cardiovascular events in syndrome MIA (HR: 4.23 95% CI: 1.89-9.50). Our study suggests that high risk cardiovascular events in patients with 2 or more elements in MIA syndrome (HR: 2.40 95% CI: 1.16-5.00). Conclusion: We had demonstrated an association between malnutrition, inflammation and atherosclerosis; component M (malnutrition) and the cardiovascular events in hemodialysis patients; high risk cardiovascular events in patients with 2 or more elements in MIA syndrome. Key words: Malnutrition-inflammation-atherosclerosis syndrome, hemodialysis

Background: Although procalcitonin (PCT) has been described as a new marker of inflammation in dialysis patients, it has not been studied in patients with end-stage renal disease (ERSD) in Viet Nam. The objective of this study was to evaluate: serum PCT levels in patients with ERSD and its association to other inflammation (hs-CRP, IL-6) and nutritional (albumin, prealbumin, BMI) factors and the cardiovascular disease (CVD) events (heart failure, cerebrovascular disease, coronary heart disease, urgence hypertension) after 1-year follow-up. Subjects and methods: A total of 174 patients without infection (include: 57 predialysis patients, 56 continuous ambulatory peritoneal dialysis patients, 61 hemodialysis patients) were enrolled. Inflammatory markers (PCT, hs-CRP, IL-6) and nutritional parameters (albumin, prealbumin, BMI) were determined. CVD events (heart failure, cerebrovascular disease, coronary heart disease, urgence hypertension) were evaluated during 12 months of follow-up. Results: The median baseline serum PCT levels of them were 0.44 ng/ml (0.23 – 0.98). Of them, 79 patients (45.4%) had baseline serum PCT levels of over 0.5 ng/ml, which is the cut-off point suggestive of sepsis in non-dialytic individuals. Hemodialysis patients was associated with significantly higher PCT values than predialysis and peritoneal dialysis patients. The patients with elevated PCT plasma levels had the BMI lower. PCT and IL-6 were positively correlated with each other. Compared to patients with serum PCT levels of under 0.5 ng/ml, patients with serum PCT levels of over 0.5 ng/ml had an increased CVD risk in 12 months of follow-up (HR: 2.09; 95% CI: 1.31-3.33; p=0.002). Conclusion: In the absence of infection, PCT may increase due to reduced renal elimination and increased synthesis. Furthermore, serum PCT could serve as a marker of low-grade inflammation, which substantially increase CVD events risk in patients with ERSD. Keywords: Procalcitonin, end-stage renal disease

Background: the role of malnutrition, inflammation, atherosclerosis, and particularly the combination of these three factors were closely related to cardiovascular events, hospitalisation frequency, and death in end-stage renal disease (ESRD) patients. This study examines the relationship between malnutrition-inflammation-atherosclerosis (MIA) syndrome and mortality among these patients during an 18-month period. Subjects and methods: in this prospective observational cohort study, all cause-mortality was evaluated during an 18-month follow-up period. A total of 174 patients with ESRD (including 57 non-dialysis patients, 56 peritoneal dialysis patients, and 61 hemodialysis patients) were enrolled. M (malnutrition) was assessed by the seven-point subjective global assessment (SGA), serum albumin. I (inflammation) was assessed by serum hs-CRP, serum IL-6. A (atherosclerosis) was defined as IMT ≥0.9 mm or the presence of plaque in the carotid artery. The patients are classified into four groups by number of components (MIA0, MIA1, MIA2, MIA3). Results: 73.6% of patients had at least one component of MIA syndrome. The proportion of patients with malnutrition, inflammation, and atherosclerosis accounted for 36.8%, 21.3%, and 50.6%, respectively. The proportion of patients with 3, 2, 1 component accounted for 4.0, 27.0, and 42.5%. There was no difference between MIA groups based on age, sex, percentage suffering from dyslipidemia, anemia, or Hb levels. Relative to patients experiencing no elements of MIA syndrome, patients with three components experienced a 13.16 times higher risk of mortality. Only malnutrition was a strong predictor of mortality with HR (95% CI): 5.90 (2.46-14.14). Conclusion: clinical physicians should attend more closely to and provide early assessments of MIA syndrome in patients with ESRD. They should care for nutrition conditions and thereby provide early and effective treatments. This can contribute to enhancements in quality of life, and decrease mortality rates in patients.