Malnutrition leads to the progression of coronary artery calcification in hemodialysis patients

Abstract

Background Malnutrition is considered a risk factor for cardiovascular disease in patients with chronic kidney disease. However, no in vivo studies have reported on using optical coherence tomography to evaluate the effect of nutritional status on coronary atherosclerosis in hemodialysis patients. We aimed to conduct a detailed analysis of the effect of nutritional status on the coronary arteries in hemodialysis patients. Methods Among 64 hemodialysis patients who underwent percutaneous coronary interventions, 41 that underwent optical coherence tomography imaging were included in this study. And, among them, 24 patients that could also be evaluated using OCT also at the 6-month follow-up were included in this study. The patients were divided into two groups based on nutritional evaluation using the geriatric nutritional risk index. Culprit and non-culprit lesions were evaluated at baseline and after 6 months. Results In the culprit lesions at baseline, the length of the lipid plaque was significantly smaller in the malnutrition group. In contrast, the thickness and length of the calcified plaque and the angle of the calcified nodule were significantly larger (each p < 0.01). In the non-culprit lesions, the 6-month change in the angle of the calcified plaque was significantly greater in the malnutrition group (p = 0.02). The significant factors that affected the change in the angle of calcification were "malnutrition at geriatric nutritional risk index" [odds ratio, 8.17; 95% confidence interval, 1.79 to 37.33; p < 0.01] and "serum phosphorus level" (odds ratio, 3.73; 95% confidence interval, 1.42 to 9.81; p < 0.01). Conclusions Appropriate management of nutritional status is crucial for suppressing the progression of coronary artery disease in hemodialysis patients.

Cardiovascular Event Predictors in Hospitalized Chronic Kidney Disease (CKD) Patients: A Nationwide Inpatient Sample Analysis

“…These findings suggest that these factors may contribute to the development and progression of acute coronary syndromes in CKD patients. Consistent with a study by Okabe et al (2023), which investigated the impact of nutritional status on the development of coronary atherosclerosis in CKD patients, the current findings highlight the notable correlation between malnutrition and the progression of coronary artery calcification [22]. However, unlike the results of the index study, a recent cohort study (Rhee et al, 2020) reported a high prevalence of uremic symptoms among CKD patients in the United States, indicating the need for further investigation into the relationship between uremic syndrome and acute coronary events [23].…”

Molecular Linkage between Immune System Disorders and Atherosclerosis

“…The volume of calcified plaques and calcified nodules was higher in the malnourished state, while the volume of lipid plaques was lower. The analysis revealed that low nutritional status and serum phosphorus levels were independent predictors of progression of calcified plaques [95].…”

“…Most publications on malnutrition and atherosclerosis focus on patients with chronic renal failure, including those on dialysis [94][95][96]. A study by Okabe et al confirmed that malnutrition leads to the progression of coronary artery calcification in hemodialysis patients.…”

Role of composite objective nutritional indexes in patients with chronic kidney disease

“…2 Relationship between malnutrition, inflammation, cardiovascular disease, and mortality in chronic kidney disease Patients with CKD exhibit a higher prevalence of cardiovascular disease (CVD) and increased mortality than those without CKD (6). In a study by Okabe et al, the influence of nutritional conditions on coronary atherosclerosis was investigated in patients undergoing hemodialysis (HD) using optical coherence tomography (7). Their findings revealed that malnourished patients exhibited larger calcified plaques in affected areas at baseline and demonstrated a more significant change in calcified plaque angle in unaffected areas after 6 months.…”