Malnutrition–Inflammation Complex Syndrome and Hepatitis C in Maintenance Hemodialysis Patients

Abstract

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%).

Comparison of Nutritional Parameters among Adult and Elderly Hemodialysis Patients

“…Nutrient intake, as estimated by means of dietary recall or by calculating the protein catabolic rate (PCR) was included in the minimal nutritional assessment recommended by the KDOQI in 2000 34. nPCR should be measured in clinically stable HD patients and be above 1.0 g/kg /day 31. In the present study, nPCR values in elderly HD group were lower than in the adult HD group.…”

“…Particularly in HD patients, this condition tends to occur concomitantly and coexist with the Malnutrition-Inflammation Complex Syndrome and Malnutrition, Inflammation and Atherosclerosis Syndrome 31. These syndromes directly affect the mortality and morbidity of dialysis patients.…”

The relationship between glutathione peroxidase and bioimpedance parameters in nondiabetic hemodialysis patients

“…Chronic inflammation may cause hypocholesterolemia, which indicates poor nutritional status and a poor outcome in HD patients. Vlatkovic et al., observed that the CHOL was within the reference range and did not differ significantly between HCV‐negative and ‐positive patients. In our study group, the CHOL did not differ significantly between HCV‐negative (190.7 ± 61.0) and HCV‐positive patients (166.2 ± 35.7).…”

“…Although the recovery of visceral proteins, specifically albumin, after inflammatory events occurs fairly quickly, the regeneration of lost somatic proteins, specifically muscle, is less likely . Because these conditions tend to occur concomitantly and coexist in individuals with ESRD, the terms malnutrition–inflammation complex syndrome (MICS) and malnutrition, inflammation and atherosclerosis syndrome have been proposed to indicate the combination of these two conditions in ESRD patients …”

“…18,35 Because these conditions tend to occur concomitantly and coexist in individuals with ESRD, the terms malnutrition-inflammation complex syndrome (MICS) and malnutrition, inflammation and atherosclerosis syndrome have been proposed to indicate the combination of these two conditions in ESRD patients. 36,37 BMI is considered as a marker of the nutritional status in HD patients, but it has been associated with a low relative risk of mortality in HD patients, and body composition may differ in patients with the same BMI. 27,38 In the study of Vlatkovic et al, 36 the mean BMI of HCVseropositive patients was insignificantly lower compared with HCV-negative subjects.…”