Arterial Stiffness, Malnutrition and Inflammation in Chronic Hemodialysis Patients.
- Author:
Min Ha JOO
1
;
Ja Ryong KOO
;
Jong Yoo YOON
;
Sang Jin HAN
;
Young Lim SONG
;
Soo Jin SONG
;
Young Soo SONG
;
Seong Gyun KIM
;
Ji Eun OH
;
Young Ki LEE
;
Jang Won SEO
;
Hyung Jik KIM
;
Jung Woo NOH
Author Information
1. Department of Internal Medicine, Kidney Research Center, Hallym University,College of Medicine, Chunchon, Korea. jrkoo@hallym.ac.kr
- Publication Type:Original Article
- Keywords:
Arteriosclerosis;
Malnutrition;
Inflammation;
Hemodialysis
- MeSH:
Arteriosclerosis;
Atherosclerosis;
Blood Pressure;
C-Reactive Protein;
Extracellular Fluid;
Humans;
Hypoalbuminemia;
Inflammation*;
Intracellular Fluid;
Kidney Failure, Chronic;
Male;
Malnutrition*;
Nomograms;
Nutritional Status;
Plethysmography;
Pulse Wave Analysis;
Renal Dialysis*;
Risk Factors;
Serum Albumin;
Vascular Stiffness*
- From:Korean Journal of Nephrology
2006;25(3):431-437
- CountryRepublic of Korea
- Language:Korean
-
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.
