The aim of this study was to assess the prevalence of malnutrition-inflammation complex syndrome (MICS) and determine sensitivity and specificity of MICS markers in hemodialysis (HD) patients depending on volume status. The study included 124 patients undergoing adequate HD. The patients were distributed based on IDWG (interdialytic weight gain)/DBW (dry body weight) and IDWG/ TBW (total body water) ratios in 4 groups: 1 -IDWG/DBW ≤ 5%and IDWG/TBW ≤10%; 2 -IDWG/DBW ≤5% and IDWG/TBW >10%; 3 -IDWG/DBW >5% and IDWG/TBW ≤10%, and 4 -IDWG/DBW > 5% and IDWG/TBW > 10%. MICS was evaluated based on malnutrition and inflammation markers. Data were analyzed with ANOVA, chi-square test, R.O.C. curve and Odds ratio, using SPSS software; p <0.05 was considered statistically significant. A significant difference was found in patients' distribution pattern according to IDWG/DBW and IDWG/TBW ratios (p <0.0001). The rate of volume overload, represented with IDWG/TBW >10%, was significantly higher in patients in groups 3 and 4. Groups also differed in age (F=3.3, p <0.02) and residual diuresis (F=2.3, p <0.05). In spite of different volume status, systolic and diastolic blood pressure did not differ significantly between groups. Serum sodium (p <0.043) and chloride (p <0.035) differed significantly between groups -patients in group 1 had highest, while patients in group 4 had lowest sodium and chloride levels. CRP levels did not differ significantly between groups. The highest prevalence of MICS was found in group 4 (up to 30%). BMI had strongest predictive value for MICS in groups 1 and 4 (p = 0.000 and p = 0.002 respectively), followed by malnutrition-inflammation score, MIS (p = 0.053 and p = 0.057 respectively). Ferritin and BMI were the strongest predictors of MICS in group 3 (p = 0.023 and p = 0.051 respectively). Patients in group 4 had three times higher chances to have MICS then those in group 3 (OR = 3, CI: 1.7645 < O.R. < 5.1007). In this study, the excessive volume overload implied increased risk and high prevalence of MICS. Low BMI and MIS appeared to be the most sensitive predictors of MICS, while low BMI also represented strong risk factor for disturbed fluid balance.

Maintenance hemodialysis (HD) patients often experience fluctuations of volume status. Although hypervolemia possibly induces systemic inflammation, the relationship between volume status and leptin has not yet been well defined. The aims of this study were to determine the levels of leptin, C-reactive protein (CRP), and ferritin in relation to volume status and to assess the relationship between leptin and volume and inflammatory status in chronic HD patients. This prospective study included 93 HD patients divided, based on evaluation using the body composition monitor, into normovolemic and hypervolemic groups (overhydration/extracellular water [OH/ECW] ≤ 15% and OH/ECW > 15%, respectively). The levels of leptin and inflammatory markers (CRP, ferritin) were determined during a mid-week dialysis session in all patients. There were more hypervolemic patients after 12 months of follow up than at baseline (41% vs. 38%). Hypervolemic patients had significantly lower leptin levels (11.42 ± 19.24 ng/mL vs. 34.53 ± 40.32 ng/mL at baseline and 13.41 ± 22.04 ng/mL vs. 41.54 ± 21.78 ng/mL at 12 months), longer time on dialysis, and poorer nutritional status than normovolemic patients. Inflammation was present regardless of the volume status, but hypervolemic patients had significantly higher CRP and ferritin than normovolemic patients. A statistically significant reverse correlation was found between leptin level, hyperhydration index, and OH/ECW. No significant correlation was found between leptin and inflammatory markers CRP and ferritin.

The increased presence of beta-NAG in the urine of DM type 2 patients, pointed out an early tubular disorder and damage of cells, while gamma-GT was a less sensitive indicator of this damage.

Protein-energy malnutrition and inflammation are among the leading causes of poor outcome in hemodialysis patients. Hepatitis C virus (HCV) infection is accompanied by elevated proinflammatory mediators, also found in dialysis patients with malnutrition-inflammation complex syndrome. We aimed to study the rate and characteristics of malnutrition-inflammation complex syndrome (MICS) in hemodialysis patients, especially those with hepatitis C. The study included 147 patients (mean age 55.1 +/- 12.9 years), 24.5% of whom were HCV-positive, undergoing adequate hemodialysis three times a week for the last 52.7 +/- 52.5 months. Parameters of nutrition and inflammation were investigated to evaluate MICS. HCV-positive vs. HCV-negative patients had significantly higher hematocrit (29.6 +/- 4.5 g/dL vs. 28.1 +/- 4.3, P < 0.05), uric acid (345.8 +/- 96.5 vs. 321.3 +/- 118.8 micromol/mL, P < 0.05), aspartate aminotransferase (AST, also known as serum glutamic oxaloacetic transaminase [SGOT]) (23.3 +/- 14.9 vs. 17.8 +/- 9 U/L, P < 0.008), alanine aminotransferase (ALT, also known as serum glutamic pyruvic transaminase [SGPT]) (41.2 +/- 28.7 vs. 26.6 +/- 17.1 U/L, P < 0.0003), serum creatinine (980.4 +/- 219.1 vs. 888.4 +/- 202.9 micromol/mL, P < 0.022), intact parathyroid hormone (329.7 +/- 630.5 vs. 110.2 +/- 145.3 pg/mL, P < 0.002), malnutrition-inflammation score (7.4 +/- 5.2 vs. 5.6 +/- 4.1, P < 0.038), and Charlson comorbidity index (4.5 +/- 1.5 vs. 4 +/- 1.4, P < 0.05). MICS had a prevalence of 20-40% in our study. HCV-positive patients had a significantly higher prevalence of MICS than HCV-negative patients (30-40% vs. 20-30%).

The application of OCM has shown that it is the most rigorous parameter for the assessment of adequacy and that its regular use would contribute to increasing of the delivered dialysis dose and improvement of the treatment quality.