The Malnutrition-Inflammation-Depression-Arteriosclerosis Complex Is Associated with an Increased Risk of Cardiovascular Disease and All-Cause Death in Chronic Hemodialysis Patients

Choi, Moon-Gi; Seo, Jang-Won; Yoon, Jong‐Woo; Lee, Sang‐Kyu; Kim, Soojin; Lee, Young-Ki; Noh, Jung‐Woo; Koo, Ja Ryong

doi:10.1159/000348509

Cited by 31 publications

(34 citation statements)

References 34 publications

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“…7 There was a positive and significant variation of MIS score over time, independent of the presence of DS, reinforcing the contribution of inflammation to the metabolic derangement that accompanies ESRD. Again, no relationship with DS prevalence was observed across nutritional status groups.…”

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confidence: 77%

“…MIDA has been shown to be an independent risk factor for cardiovascular disease, and is associated with higher morbidity and mortality. 7 DS appear to be associated with a higher mortality rate since the start of renal replacement therapy: patients presenting with DS may have a 2.7-fold higher risk of death than those without DS. 8 As DS have a negative effect on QoL and are associated with increased morbidity and mortality, early diagnosis and treatment of these symptoms should be sought in all CKD patients, regardless of disease stage.…”

Section: Introductionmentioning

confidence: 98%

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Depression, quality of life, and body composition in patients with end-stage renal disease: a cohort study

Barros

Costa

Mottin

et al. 2016

Rev. Bras. Psiquiatr.

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Objective: To prospectively evaluate depressive symptoms, nutritional status, and quality of life (QoL) and search for possible associations in patients with end-stage renal disease undergoing hemodialysis. Methods: A cohort study of 104 adult patients with end-stage renal disease undergoing hemodialysis was conducted. Anthropometric, clinical, and biochemical variables were evaluated after a midweek hemodialysis session. The participants' body composition was assessed by direct segmental multifrequency bioimpedance analysis. The WHOQOL-Bref questionnaire was used to evaluate QoL. Participants were separated into two groups -depressive symptoms and no depressive symptoms -at inclusion and evaluated annually for 2 years thereafter using the Beck Depression Inventory. Survival analysis used the Kaplan-Meier method and Cox regression analysis for the goodness of fit of associated factors. All-cause mortality was the outcome of interest. Results: Participants' mean age was 55.3615.6 years, 60% were male, and the median time on hemodialysis was 17.5 (8.0-36.8) months. Thirty-two patients had depressive symptoms and a significantly lower QoL compared with the 72 patients in the no depressive symptoms group. The fitted outcome model showed that lean body mass had a protective effect against all-cause mortality (hazard ratio [HR] = 0.89; 95%CI 0.80-0.99; p = 0.038). Conclusion: Depressive symptoms were highly prevalent in the cohort, and correlated with the physical and psychological components of the QoL life questionnaire, as well as with C-reactive protein and phosphorus levels. Lean body mass was protective for the assessed outcome.

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mentioning

confidence: 77%

Section: Introductionmentioning

confidence: 98%

Depression, quality of life, and body composition in patients with end-stage renal disease: a cohort study

Barros

Costa

Mottin

et al. 2016

Rev. Bras. Psiquiatr.

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“…Recently, a strong association between malnutrition, inflammation, and arteriosclerosis/atherosclerosis (the so-called MIA syndrome) have been described and proposed as the main causes of morbidity and mortality in chronic hemodialysis patients [1, 4–6]. Among the MIA components, inflammation seems to play a pivotal role in the pathogenesis of malnutrition and arteriosclerosis by the following mechanisms: (1) inflammatory response is responsible for malnutrition by increased protein catabolism and muscle wasting [4, 6]; and (2) uremic inflammation is known to promote extra-osseous deposition of calcium to vessel walls, resulting in vascular calcification and arteriosclerosis [7]. …”

Section: Introductionmentioning

confidence: 99%

Extracellular Fluid/Intracellular Fluid Volume Ratio as a Novel Risk Indicator for All-Cause Mortality and Cardiovascular Disease in Hemodialysis Patients

et al. 2017

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BackgroundIn hemodialysis patients, fluid overload and malnutrition are accompanied by extracellular fluid (ECF) expansion and intracellular fluid (ICF) depletion, respectively. We investigated the relationship between ECF/ICF ratio (as an integrated marker reflecting both fluid overload and malnutrition) and survival and cardiovascular disease (CVD) in the context of malnutrition-inflammation-arteriosclerosis (MIA) complex.MethodsSeventy-seven patients from a single hemodialysis unit were prospectively enrolled. The ECF/ICF volume was measured by segmental multi-frequency bioimpedance analysis. MIA and volume status were measured by serum albumin, C-reactive protein (CRP), pulse wave velocity (PWV) and plasma B-type natriuretic peptide (BNP), respectively.ResultsThe mean ECF/ICF ratio was 0.56±0.06 and the cut-off value for maximum discrimination of survival was 0.57. Compared with the low ECF/ICF group, the high ECF/ICF group (ratio≥0.57, 42%) had higher all-cause mortality, CVD, CRP, PWV, and BNP, but lower serum albumin. During the 5-year follow-up, 24 all-cause mortality and 38 CVD occurred (18 and 24, respectively, in the high ECF/ICF group versus 6 and 14 respectively in the low ECF/ICF group, P<0.001). In the adjusted Cox analysis, the ECF/ICF ratio nullifies the effects of the MIA and volume status on survival and CVD and was an independent predictor of all-cause mortality and CVD: hazard ratio (95% confidence interval); 1.12 (1.01–1.25) and 1.09 (1.01–1.18) for a 0.01 increase in the ECF/ICF ratio. The degree of malnutrition (albumin), inflammation (CRP), arteriosclerosis (PWV), and fluid overload (BNP) were correlated well with the ECF/ICF ratio.ConclusionsHemodialysis patients with high ECF/ICF ratio are not only fluid overloaded, but malnourished and have stiff artery with more inflammation. The ECF/ICF ratio is highly related to the MIA complex, and is a major risk indicator for all-cause mortality and CVD.

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“…Hypoalbuminemia is a nontraditional risk factor for cardiovascular diseases (CVD) in HD patients [23]. So, hypoalbuminemia could be a factor, which accelerates IHD in those patients.…”

Section: Discussionmentioning

confidence: 99%

The Relationship between Hypoalbuminemia and Intradialytic Hypotension in Haemodialysis Patients

Kora¹,

Tawfeek²,

Elzorkany³

et al. 2018

J Kidney

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Objective: To evaluate the relationship between Serum albumin and Intradialytic Hypotension (IDH). Background: Hypoalbuminemia and Intradialytic Hypotension (IDH) is a common complication during HD session. Hypotension is a risk factor for mortality and morbidity in HD patients. Patients and methods: We conducted a cross-sectional study on 50 patients with ESRD who received regular hemodialysis session 3 times weekly for more than 3 months (from April to July 2017) at Ashmoun General Hospital. They have been divided into two groups; Group 1: Patients of this group developed recurrent attacks of IDH and Group 2: Patients of this group did not develop IDH. Data collected from each patient included: (I) Demographic features, clinical features (blood pressure changes during session, ultrafiltration rate, intradialytic weight gain (IDWG), duration of dialysis, cause of ESRD, surface area of dialyzer and blood flow of the machine), (II) Blood chemistry (creatinine, urea, hemoglobin, hematocrit value, albumin, triglycerides, cholesterol, AST, ALT, Na*,K*and KT/V), (III) Echocardiographic assessment of left ventricular geometry and (IV) IVC guided ultrasonography. Result: Serum albumin level among group I ranged between 2.4-4.7 mg/dl with mean ± SD 3.1 ± 0.53 mg/dl, while in group II serum albumin level ranged between 2.6-4.6 mg/dl with mean ± SD 3.6 ± 0.48 mg/dl with p-value 0.002 and there were a high significant difference between both groups. Conclusion: We concluded that serum albumin is a parameter which is associated with intradialytic hypotension and found that beside measurement of IVCC and IVCD are easy and good markers for prediction of intradialytic hypotension.

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The Malnutrition-Inflammation-Depression-Arteriosclerosis Complex Is Associated with an Increased Risk of Cardiovascular Disease and All-Cause Death in Chronic Hemodialysis Patients

Cited by 31 publications

References 34 publications

Depression, quality of life, and body composition in patients with end-stage renal disease: a cohort study

Depression, quality of life, and body composition in patients with end-stage renal disease: a cohort study

Extracellular Fluid/Intracellular Fluid Volume Ratio as a Novel Risk Indicator for All-Cause Mortality and Cardiovascular Disease in Hemodialysis Patients

The Relationship between Hypoalbuminemia and Intradialytic Hypotension in Haemodialysis Patients

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