Malnutrition-inflammation complex syndrome in dialysis patients: causes and consequences.
Kamyar Kalantar-Zadeh,Kamyar Kalantar-Zadeh,T. Alp Ikizler,Gladys Block,Morrel M. Avram,Joel D. Kopple,Joel D. Kopple,Joel D. Kopple +7 more
TL;DR: Because MICS leads to a low body mass index, hypocholesterolemia, hypocreatininemia, and hypohomocysteinemia, a "reverse epidemiology" of cardiovascular risks can occur in dialysis patients, obesity, hypercholesterolesmia, and increased blood levels of creatinine and homocysteine appear to be protective and paradoxically associated with a better outcome.
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About: This article is published in American Journal of Kidney Diseases. The article was published on 01 Nov 2003. and is currently open access. The article focuses on the topics: Dialysis & Malnutrition–inflammation complex.
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Figures
Table 1. Causes of Wasting and PEM in Dialysis Patients 
Table 4. Some Acute-Phase Reactants for Which Blood Concentrations Are Measured as Markers of Inflammation in Patients With Renal Insufficiency 
Table 3. Possible Causes of Inflammation in Patients With CKD and ESRD 
Fig 1. Mean levels of biochemical measures of nutritional status as a function of glomerular filtration rate (GFR) in the Modification of Diet in Renal Disease Study. Estimated mean levels with 95% confidence limits of biochemical nutritional markers are shown as a function of GFR (males, solid line; females, dashed line) controlling for age, race, and use of protein- and energy-restricted diets. In men, the slope of the relationship was greater at a GFR of 12 mL/min/1.73 m2 than 55 mL/min/1.73 m2 for serum total cholesterol (P 0.014). (A) Males, N 1,065 (P 0.004); females, N 698 (P < 0.001); (B) males, N 1,065 (P < 0.001); females, N 698 (P < 0.001); (C) males, N 1,063 (P 0.052); females, N 694 (P 0.63); (D) males, N 1,017 (P < 0.001); females, N 664 (P < 0.001). To convert albumin in g/dL to g/L, multiply by 10; transferrin in mg/dL to g/L, multiply by 0.01; cholesterol in mg/dL to mmol/L, multiply by 0.02586. Used with permission from Kidney International, vol 57, pages 1688-1703, 2000.36 
Fig 2. Schematic representation of the causes and consequences of MICS. Abbreviation: DM, diabetes mellitus. 
Table 2. Systematic Classification of Assessment Tools for Evaluation of PEM in Maintenance Dialysis Patients
Citations
A proposed nomenclature and diagnostic criteria for protein–energy wasting in acute and chronic kidney disease
Denis Fouque,Kamyar Kalantar-Zadeh,Joel D. Kopple,Noël Cano,Philippe Chauveau,Lilian Cuppari,Harold A. Franch,Gabriele Guarnieri,Talat Alp Ikizler,George A. Kaysen,Bengt Lindholm,Ziad A. Massy,William E. Mitch,E. Pineda,Peter Stenvinkel,A. Trevinho-Becerra,Christoph Wanner +16 more
TL;DR: An expert panel to review and develop standard terminologies and definitions related to wasting, cachexia, malnutrition, and inflammation in CKD and AKI recommends the term 'protein-energy wasting' for loss of body protein mass and fuel reserves.
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Epidemiology of cardiovascular disease in chronic renal disease
TL;DR: The risk of cardiovascular disease in patients with chronic renal disease appears to be far greater than in the general population as mentioned in this paper, even after stratification by age, gender, race, and the presence or absence of diabetes.
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Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure
TL;DR: Traditional risk factors of a poor clinical outcome and mortality in the general population, including body mass index, serum cholesterol, and blood pressure, are also found to relate to outcome in patients with chronic heart failure, but in an opposite direction.
707
Survival advantages of obesity in dialysis patients
Kamyar Kalantar-Zadeh,Kevin C. Abbott,Abdulla K Salahudeen,Ryan D. Kilpatrick,Tamara B. Horwich +4 more
TL;DR: The causes and consequences of the reverse epidemiology of obesity in dialysis patients can enhance insights into similar paradoxes observed for other conventional risk factors, such as blood pressure and serum cholesterol and homocysteine concentrations, and in other populations such as those with CHF, advanced age, cancer, or AIDS.
635
The Gut as a Source of Inflammation in Chronic Kidney Disease
TL;DR: The evidence points to a strong relationship between intestinal inflammation and adverse outcomes in CKD, and more trials investigating gut-targeted therapeutics are needed.
References
Nutrition in end-stage renal disease
T. Alp Ikizler,Raymond M. Hakim +1 more
TL;DR: It is important to emphasize that malnutrition is a major co-morbid condition in the ESRD population and that the nutritional status and the treatment parameters of these patients should be altered to improve not only the mortality outcome of E SRD patients but also their quality of life.
316
Effect of malnutrition-inflammation complex syndrome on EPO hyporesponsiveness in maintenance hemodialysis patients.
Kamyar Kalantar-Zadeh,Charles J. McAllister,Robert S. Lehn,Grace H. Lee,Allen R. Nissenson,Joel D. Kopple +5 more
TL;DR: The existence of elements of MICS as indicated by a high MIS and increased levels of proinflammatory cytokines such as IL-6 as well as decreased nutritional values such as low serum concentrations of total cholesterol, prealbumin, and TIBC correlates with EPO hyporesponsiveness in MHD patients.
308
HMG-CoA reductase inhibitors are associated with reduced mortality in ESRD patients.
Stephen L. Seliger,Noel S. Weiss,Noel S. Weiss,Noel S. Weiss,Daniel L. Gillen,Daniel L. Gillen,Daniel L. Gillen,Bryan Kestenbaum,Bryan Kestenbaum,Bryan Kestenbaum,Adrianne Ball,Adrianne Ball,Adrianne Ball,Donald J. Sherrard,Donald J. Sherrard,Donald J. Sherrard,Catherine Stehman-Breen,Catherine Stehman-Breen,Catherine Stehman-Breen +18 more
TL;DR: Whether the use of statins is associated with a reduction in cardiovascular-specific death and total mortality in ESRD patients with end-stage renal disease is determined.
305
Net uptake of plasma homocysteine by the rat kidney in vivo
TL;DR: The data suggest that loss of the sizable homocysteine metabolizing capacity of the intact kidneys may be an important determinant of the refractory, potentially atherothrombotic hyperhomocysteinemia frequently observed in ESRD.
233
Inflammation is associated with carotid atherosclerosis in dialysis patients
Carmine Zoccali,Francesco A. Benedetto,Francesca Mallamaci,Giovanni Tripepi,Isabella Fermo,Alfredo Focà,Rita Paroni,Lorenzo Malatino +7 more
TL;DR: In patients on chronic dialysis treatment CRP is independently associated to carotid atherosclerosis and appears at least in part to be explained by IgG anti-Chlamydia pneumoniae antibodies level, which lends support to the hypothesis that inflammation plays a role in the pathogenesis of Atherosclerosis in these patients.
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