Malnutrition, a new inducer for arterial calcification in hemodialysis patients?

Abstract

BackgroundArterial calcification is a significant cardiovascular risk factor in hemodialysis patients. A series of factors are involved in the process of arterial calcification; however, the relationship between malnutrition and arterial calcification is still unclear.Methods68 hemodialysis patients were enrolled in this study. Nutrition status was evaluated using modified quantitative subjective global assessment (MQSGA). Related serum biochemical parameters were measured. And the radial artery samples were collected during the arteriovenous fistula surgeries. Hematoxylin/eosin stain was used to observe the arterial structures while Alizarin red stain to observe calcified depositions and classify calcified degree. The expressions of bone morphogenetic protein 2 (BMP2) and matrix Gla protein (MGP) were detected by immunohistochemistry and western blot methods.Results66.18% hemodialysis patients were malnutrition. In hemodialysis patients, the calcified depositions were mainly located in the medial layer of the radial arteries and the expressions of BMP2 and MGP were both increased in the calcified areas. The levels of serum albumin were negatively associated with calcification score and the expressions of BMP2 and MGP. While MQSGA score, serum phosphorus and calcium × phosphorus product showed positive relationships with calcification score and the expressions of BMP2 and MGP.ConclusionsMalnutrition is prevalent in hemodialysis patients and is associated with arterial calcification and the expressions of BMP2 and MGP in calcified radial arteries. Malnutrition may be a new inducer candidate for arterial calcification in hemodialysis patients.

Evaluation of nutritional status with anthropometric measurements and MQSGA in geriatric hemodialysis patients

“…Although lower total cholesterol levels were observed in malnurished geriatric MHD patients, this study found no statically significant correlation between MQSGA scores and cholesterol levels [17, 18]. Serum phosphorus levels were found low in elderly patients and this was considered as related with poor nutritional intake.…”

MICS, an easily ignored contributor to arterial calcification in CKD patients

“…It is found that about 92% young ESRD patients had coronary artery calcification (CAC) (78). In hemodialysis patients, we observed that nearly 46% of them suffered different degree of radial calcification (110). In addition, we also found that the calcified depositions were mainly located in the medial layer of the radial arteries, leading to thickening of the medial layer (110).…”

“…However, our previous study found an increase of MGP and BMP2 expressions in the calcified areas of radial arteries in malnourished ESRD patients (110). This may be attributed to the lower ratio of MGP/BMP2 or the uncarboxylated form of MGP.…”

“…In hemodialysis patients, we observed that nearly 46% of them suffered different degree of radial calcification (110). In addition, we also found that the calcified depositions were mainly located in the medial layer of the radial arteries, leading to thickening of the medial layer (110). The bad consequence of medial calcification is that it increases arterial stiffness, pulse wave velocity, decreases arterial compliance and ultimately leads to severe cardiovascular events (8,59).…”

“…The association between undernutrition and adverse outcomes in ESRD patients has been referred to as reverse epidemiology (36,38). Recently, our and others' findings show that MICS is associated with AC (109,110), which may serve as an explanation for the bad consequences of reverse epidemiology in ESRD patients. In this review, in order to give clinicians in-depth insights into MICS for AC in CKD, we evaluated the roles of MICS in AC and explored the possible mechanisms for MICS-induced AC.…”