Nonalcoholic fatty liver disease (NAFLD) – a new factor that interplays between inflammation, malnutrition, and atherosclerosis in elderly hemodialysis patients

Abstract

Background/aimIn 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.MethodsUsing 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).ResultsThe 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.ConclusionOur 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.

Using controlled attenuation parameter combined with ultrasound to survey non-alcoholic fatty liver disease in hemodialysis patients: A prospective cohort study

“…The number of patients in those studies was limited, however, with the largest number of cases in any of the studies being only 94 [20–23]. …”

Relationship between non‐alcoholic fatty liver disease and MIA syndrome

“…Malnutrition in patients undergoing dialysis has been attributed to many factors, such as insufficient nutrient intake, dialysis inadequacy, acidosis, hormone derangement, and inflammation. Malnutrition and inflammation are common and usually concurrent in chronic patients undergoing HD; it has been suggested that in patients with CKD, “inflammation” is the most important factor associated with poor nutritional state . According to the literature, pro‐inflammatory cytokines represent a common link between malnutrition, inflammation, and atherosclerosis (MIA syndrome) in this population of patients.…”

“…Numerous authors have shown that cardiovascular diseases (CVDs) remain the most common cause of mor-that in patients with CKD, "inflammation" is the most important factor associated with poor nutritional state. [1][2][3][4][5][6] According to the literature, pro-inflammatory cytokines represent a common link between malnutrition, inflammation, and atherosclerosis (MIA syndrome) in this population of patients. However, as malnutrition occurs in patients undergoing pre-dialysis as well, it is evident that dialysis-unrelated factors e.g., infectious and inflammatory complications and comorbidities may also be important contributors to malnutrition in CKD.…”

Body mass index: short- and long-term impact on kidney transplantation

“…Over the last decade, the number of overweight and obese patients awaiting kidney transplantation has been increasing. There is conflicting data about the association of high pretransplant BMI with posttransplant graft and patient survival in renal transplant recipients (RTRs) (1)(2)(3)(4)(5)(6)(7)(8). Previous studies have reported that higher BMI is associated with poorer outcome in RTRs (9,10).…”