Malnutrition associated with inflammation in the chronic renal patient on hemodialysis

Abstract

SUMMARY INTRODUCTION Malnutrition-Inflammation-Atherosclerosis Syndrome is very frequent in patients with chronic kidney disease on haemodialysis. In these patients, the inflammation associated with malnutrition is observed by the Malnutrition-Inflammation Score. OBJECTIVE To analyse the relationship between malnutrition-inflammation-atherosclerosis syndrome and anthropometric and biochemical parameters of patients on haemodialysis. METHODS A cross - sectional study was performed at the Haemodialysis Clinic of the Barão de Lucena Hospital, Recife, Brazil, between July and August 2016, with patients cared at the clinic for at least six months. Patients with amputees, hospitalized, visually impaired, HIV positive, with catheters in the neck, ascites and/or oedema, and those who were unable to provide information at the time of the interview were excluded. The patients were submitted to anthropometric evaluation for the classification of the nutritional status by waist circumference, neck circumference, body mass index, waist-to-hip ratio and waist-to-height ratio. Nutritional status related to inflammation was measured by the Malnutrition-Inflammation Score and nutritional status assessment using biochemical indicators that used urea, creatinine and albumin. RESULTS Twenty-seven individuals of both genders, adults and elderly, aged 51.3 ± 13.3 years old participated in the study. The anthropometric evaluation showed that most of the population presented cardiovascular risk. The biochemical evaluation reported low frequencies of malnutrition. Malnutrition-Inflammation-Atherosclerosis syndrome was evidenced in 3.7% of the patients. The Malnutrition-Inflammation Score had a moderate negative correlation with body mass index, waist circumference, neck circumference, waist-to-height ratio and creatinine. CONCLUSION The correlation seen among the parameters suggests that most of the parameters evaluated can be used as an indirect indicator of malnutrition-inflammation-atherosclerosis syndrome.

Association between Preoperative Nutritional Status and Clinical Outcomes of Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

“…Nutrition status plays an important role in maintaining vital organ function in the human body [17,18]. Malnutrition is associated with worse outcomes in the elderly, critically ill patients, chronic kidney disease, heart failure and ischemic stroke [5,[19][20][21]. Although nutrition status is very important, the correlation between malnutrition and cardiovascular disease has focused mainly on the CHF population.…”

“…Though the cause of the lipid paradox remains undetermined, possible explanations are that these patients have a high vascular inflammation status even though their LDL is not very high. Low lipid levels may be markers of advanced disease and systemic inflammatory activation [28], and could be a reflection of malnutrition and cachexia, which are known to be associated with increased mortality in different chronic diseases [5,[19][20][21]. Lower LDL levels may be associated with poor nutritional status, making patients more vulnerable to future events.…”

“…Higher scores reflect a worse nutritional status and have been used for nutrition status evaluation [13]. Subjects were classified as normal (0-1) or mildly (2-4), moderately (5)(6)(7)(8) or severely (9-12) malnourished based on the CONUT score. A similar classification of nutritional status has been reported in other studies [6,7].…”

“…Malnutrition is known to be associated with worse clinical outcomes in patients with heart failure, ischemic stroke, cancer and chronic kidney disease [3][4][5][6][7]. Albumin, body weight, body mass index, cholesterol, etc.…”

Estimates of malnutrition associated with chronic kidney disease patients globally and its contrast with India: An evidence based systematic review and meta-analysis

“…In India, the pooled prevalence of malnutrition among chronic kidney disease patients was found to be 56.7% (95% CI; 42.3-70.1) for the nine studies. [7][8][9][10][11][12][13][14][15] In Brazil, 39,40,17,41,18 it was found to be 26.7% (95% CI; 13.8-45.3) and in China, 42,43,19 it was found to be 37.9% (95% CI; 18.5-62.2).…”