ABSTRACT
BACKGROUND: In ESRD patients, malnutrition and atherosclerosis are strongly associated with inflammation resulting in MIA (Malnutrition-Inflammation-Atherosclerosis) syndrome. As compared with atherosclerosis, arteriosclerosis or arterial stiffening is another important cardiovascular risk factor. Therefore, we speculated on the presence of new MIA syndrome, which is composed of malnutrition, inflammation and arteriosclerosis, and evaluated causal relations among them in 70 chronic hemodialysis patients (age 53+/-13 years, male 53%, diabetes 40%). METHODS: As an indicator of arterial stiffness, brachial-ankle pulse wave velocity (PWV) was measured using a plethysmography. PWV index (measured PWV/nomogram based theoretical PWV) was then calculated to adjust confounding effects of age, blood pressure, and gender by using the PWV nomogram obtained in nonuremic population with same age, blood pressure, and gender. Nutritional status was assessed by serum albumin level, subjective global assessment (SGA) and normalized protein catabolic rate (nPCR). Extracellular fluid and intracellular fluid volume ratio (ECF/ICF) were determined using bioimpedance analysis. The presence of an inflammation was assessed by serum high sensitivity C-reactive protein (CRP) level. RESULTS: PWV index correlated positively with log transformed CRP (LnCRP) level, ECF/ICF and negatively with SGA, nPCR and serum albumin level. Serum albumin level correlated positively with nPCR, BUN, hemoglobin level and negatively with LnCRP level, age and ECF/ICF. Diabetic patients had higher PWV index and lower albumin level than non-diabetic patients. In multiple regression analysis, only LnCRP level was a significant common determinant of the both PWV index (R2=0.419; p >0.001) and serum albumin level (R2=0.543; p<0.001). CONCLUSION: Increased CRP levels are independently associated with arterial stiffening and hypoalbuminemia. Inflammation might be a linking mechanism of arterial stiffening and malnutrition in chronic hemodialysis patients.
Subject(s)
Humans , Male , Arteriosclerosis , Atherosclerosis , Blood Pressure , C-Reactive Protein , Extracellular Fluid , Hypoalbuminemia , Inflammation , Intracellular Fluid , Kidney Failure, Chronic , Malnutrition , Nomograms , Nutritional Status , Plethysmography , Pulse Wave Analysis , Renal Dialysis , Risk Factors , Serum Albumin , Vascular StiffnessABSTRACT
BACKGROUND: Depression is common in chronic renal failure patients and usually associated with poor appetite. Malnutrition with poor appetite is known to be associated with increased mortality in chronic hemodialysis (HD) patients. So we evaluated the prevalence, risk factors of depression and effects of depression to nutritional status in chronic HD patients. METHODS: Sixty two HD patients (age 48.8+/-11.1 years, diabetes 29%) were investigated. Each patients were interviewed and completed the Beck depression inventory (BDI, 21 items, 0-3 point). To exclude the possible confounding effects of illness and treatment symptoms, cognitive depression index (CDI, a cognitive subset of 15 items selected from BDI) was used as a measure of depression. KT/V and nutritional parameters such as serum albumin, normalized protein catabolic rate (nPCR), subjective global assesment (SGA), body mass index (BMI), triceps skinfold thickness (TSF) and midarm muscle circumference (MAMC) were also measured. RESULTS: Corrected BDI score (CDI score multiplied by 21/15) was 24.9+/-12.7 and the prevalence of depression (corrected BDI score > or = 21) was 64.5%. DM patients had higher CDI score than non DM patient (22.9+/-7.2 vs 15.6+/-9.0). In univariate analysis, CDI score was correlated with age (r=0.39, p<0.01), serum albumin (r=-0.37, p<0.005), nPCR (r=-0.30, p<0.05), SGA (r=-0.42, p<0.05), BMI (r=-0.28, p<0.05), TSF (r=-0.41, p<0.05) and MAMC (r=-0.50, p<0.01). In multivariate analysis, CDI score was the strongest correlate of nPCR, SGA, BMI, TSF and MAMC. But KT/V, hematocrit, erythropoietin usage, plasma bicarbonate, serum parathyroid hormone, c-reactive protein concentration and HD duration had no relationship with CDI score. CONCLUSION: The prevalence of depression in chronic HD patients was high. Diabetes and old agewere important risk factors for depression. It was also concluded that severity of depression was correlated with markers of malnutrition and depression could be a independent risk factor of malnutrition in chronic HD patients.