Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure

Stenvinkel, Peter; Heimbürger, Olof; Paultre, Furcy; Diczfalusy, Ulf; Wang, Tao; Berglund, Lars; Jogestrand, Tomas

doi:10.1046/j.1523-1755.1999.00422.x

Cited by 1,585 publications

(1,293 citation statements)

References 52 publications

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“…In patients receiving insulin therapy in the present study, insulin may have had a vasodilatory effect and therefore a renoprotective effect. In patients with renal failure, serum tumor necrosis factor-␣ (TNF-␣) concentration is reported to be increased and related to insulin resistance, malnutrition, and inflammation (25,26). Insulin resistance caused by TNF-␣ may be alleviated or partly overcome by exogenous insulin administration and may improve tissue metabolism, such as in the kidneys, possibly resulting in a renoprotective effect.…”

Section: Resultsmentioning

confidence: 99%

Factors Affecting Progression of Renal Failure in Patients With Type 2 Diabetes

et al. 2003

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OBJECTIVE -Hyperglycemia and hypertension are known to be risk factors for the development of proteinuria in patients with diabetes. Little is known, however, about predictors of progression of renal failure in diabetic patients.RESEARCH DESIGN AND METHODS -We investigated factors affecting progression of renal failure by measuring the doubling of serum creatinine (s-Cr) as an end point in a cohort of 85 type 2 diabetic patients with chronic renal insufficiency/failure (s-Cr Ͼ1.5 and Ͻ3.7 mg/dl, 61 Ϯ 11 years old, 51 men and 34 women, mean s-Cr 2.3 Ϯ 0.6 mg/dl).RESULTS -The survey period (mean Ϯ SD) was 14.2 Ϯ 10.8 months. The cumulative incidence of the end point in patients with insulin therapy (n ϭ 41) was significantly lower than that in patients without it (n ϭ 44) (P ϭ 0.0022, P values by log-rank test). Multivariate Cox analysis revealed insulin therapy (hazard ratio [HR] 0.435, 95% CI 0.252-0.750, P ϭ 0.0027), serum albumin (0.484, 284 -0.823, P ϭ 0.0074), mean blood pressure (1.023, 1.004 -1.043, P ϭ 0.017), and hemoglobin (0.841, 0.728 -0.972, P ϭ 0.0194) to be independent and significant predictors of progression to renal failure, whereas HbA 1c or serum cholesterol were not.CONCLUSION -In type 2 diabetic patients with renal failure, hypoalbuminemia, anemia, higher mean blood pressure, and lack of use of insulin predict rapid progression of renal failure, but HbA 1c does not, and insulin therapy may be possibly an indicator of the delay in progression of renal failure.

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Section: Resultsmentioning

confidence: 99%

Factors Affecting Progression of Renal Failure in Patients With Type 2 Diabetes

et al. 2003

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“…Inflammation is frequent among CKD patients and is a powerful predictor of mortality in dialysis patients (Zimmermann et al, 1999). It has been suggested that low clearance of CRP and cytokines, uremia itself, hypervolemia and the presence of comorbidities are possible causes for inducing the acute-phase reaction in dialysis patients (Stenvinkel and Yeun, 2004). We found that 43.6% of the patients (n ¼ 24) had CRP levels of 0.5 mg/dl or greater, a value considered indicative of an inflammatory condition.…”

Section: Discussionmentioning

confidence: 99%

Resting energy expenditure and its determinants in hemodialysis patients

et al. 2006

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Objective: Chronic kidney disease is associated with several metabolic disturbances that can affect energy metabolism. As resting energy expenditure (REE) is scarcely investigated in patients on hemodialysis (HD) therapy, we aimed to evaluate the REE and its determinants in HD patients. Design: Cross-sectional study. Setting: Dialysis Unit of the Nephrology Division, Federal University of São Paulo, Brazil. Subjects: The study included 55 patients (28 male, 41.4712.6 years old) undergoing HD therapy thrice weekly for at least 2 months, and 55 healthy individuals pair matched for age and gender. Subjects underwent fasting blood tests, as well as nutritional assessment, and the REE was assessed by indirect calorimetry. Results: REE of HD patients was similar to that of pair-matched controls (13797272 and 14407259 kcal/day, respectively), even when adjusted for fat-free mass (P ¼ 0.24). REE of HD patients correlated positively with fat-free mass (r ¼ 0.74; Po0.001) and body mass index (r ¼ 0.37; Po0.01), and negatively with dialysis adequacy (r ¼ À0.46; Po0.001). No significant univariate correlation was found between REE and age, dialysis vintage, serum creatinine, urea, albumin, bicarbonate, parathyroid hormone (PTH) or high-sensitivity C-reactive protein (CRP). In the multiple linear regression analysis, using REE as dependent variable, the final model showed that besides the well-recognized determinants of REE such as fat-free mass and age, PTH and CRP were the independent determinants of REE in HD patients (R 2 ¼ 0.64).

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“…Protein-energy malnutrition (PEM) is highly prevalent in end-stage renal disease (ESRD) and indices of malnutrition are powerful predictors of morbidity and mortality in this population (Lowrie & Lew, 1990;Ikizler & Hakim, 1996;Kopple et al, 1997;Stenvinkel et al, 1999). While there are possibly multiple factors that contribute to the development of PEM in ESRD patients, decreased protein and energy intake caused by anorexia is certainly an important one.…”

Section: Introductionmentioning

confidence: 99%

Influence of renal function on spontaneous dietary intake and on nutritional status of chronic renal insufficiency patients

et al. 2003

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Objective: To analyze the spontaneous food intake and the nutritional parameters of patients with different degrees of chronic renal insufficiency (CRI) at the onset of predialysis treatment. Design: Cross-sectional. Setting: Outpatient Clinic of the Nephrology Division of Federal University of São Paulo, Brazil. Subjects: The analysis involved 487 (187 women and 300 men) patients with moderate to advanced CRI who were evaluated in the first visit to the clinic. Results: Patients were divided according to creatinine clearance (CrCl) quartiles. CrCl in the first quartile was lower than 19.9 ml/min/1.73 m 2 and in the fourth one was higher than 43 ml/min/1.73 m 2 . Energy intake was significantly (Po0.05) lower in the first quartile when compared with the fourth one while protein intake estimated by protein equivalent of nitrogen appearance (PNA) was significantly lower in the first, second and third quartiles in comparison with the fourth (Po0.05). Body mass index (BMI) and percentage of ideal body weight were significantly decreased in the three lowest levels of renal function. Standard per cent of triceps skinfold thickness was lower in the first quartile when compared with the fourth one. Compared with the fourth quartile, standard per cent of midarm muscle circumference (MAMC) was lower in the second and in the third quartile. CrCl correlated directly and significantly with PNA (r ¼ 0.30; Po0.01), energy intake (r ¼ 0.17; Po0.01), and MAMC (r ¼ 0.20; Po0.01). In a multiple linear regression analysis, controlling for energy and protein intake, CrCl correlated significantly and positively with BMI and MAMC. Conclusion: This study suggests that a spontaneous decrease in energy and protein intake as well as in anthropometric indices follows a decline in renal function in patients with no previous dietary intervention. Sponsorship: This study was supported by CAPES and Oswaldo Ramos Foundation.

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Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure

Cited by 1,585 publications

References 52 publications

Factors Affecting Progression of Renal Failure in Patients With Type 2 Diabetes

Factors Affecting Progression of Renal Failure in Patients With Type 2 Diabetes

Resting energy expenditure and its determinants in hemodialysis patients

Influence of renal function on spontaneous dietary intake and on nutritional status of chronic renal insufficiency patients

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