[Inflammatory markers in dialysis: epidemiological data]. / Les marqueurs inflammatoires chez les dialysés: données épidémiologiques.

Inflammatory markers such as C-reactive protein are frequently elevated in patients treated by dialysis. Serum concentration of these markers are much higher than in the general population, in which it has been clearly shown that chronic inflammation is associated to the occurrence of cardiovascular events. The mechanisms leading to chronic inflammation in dialysis patients may be related to chronic inflammation per se, or to dialysis. Furthermore, in these patients, raised inflammatory markers are associated to malnutrition and increased cardiovascular morbidity and mortality. The association of inflammation, malnutrition and atherosclerosis defines the so-called MIA syndrome.

[Does nutrition affect the prognosis of aged hemodialysis patients?]. / L'état nutritionnel influence-t-il le pronostic des sujets âgés traités par hémodialyse?

Most authors agree that the prevalence of malnutrition is increased in patients treated by dialysis, particularly in the elderly. Malnutrition is a powerful risk factor for mortality; however, the strong association between nutritional status and mortality does not mean a causal relationship. It has been proposed that nutritional disorders that may occur in dialysis patients are mainly related to two different mechanisms. The first type of malnutrition is associated with a low protein and energy intake due to uremic toxicity, to physical changes and to psychosocial and psycho economic factors frequently found in the elderly. The second type of malnutrition is associated with increased protein catabolism from inflammatory origin. In the later case there are strong interactions between atherosclerotic cardiovascular disease, inflammation and nutritional parameters. Up to now the treatments have aimed at improving nutritional intake by increasing dialysis doses in association with dietary counselling and protein/calories supplementation. Complementary anti-inflammatory therapies acting on the inflammatory component of malnutrition may have a beneficial effect on the outcome of these patients.