Validation of the high mortality rate of Malnutrition-Inflammation-Atherosclerosis syndrome

Sueta, Daisuke; Hokimoto, Seiji; Sakamoto, Kenji; Akasaka, Tomonori; Tabata, Noriaki; Kaikita, Koichi; Honda, Osamu; Naruse, Masahiro; Ogawa, Hisao

doi:10.1016/j.ijcard.2016.12.072

Cited by 60 publications

(51 citation statements)

References 21 publications

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“…2 ). A close association between the number of concomitantly present components of the malnutrition-inflammation-atherosclerosis syndrome and high mortality was observed among 5,813 Japanese HD patients [28] .…”

Section: Cardiovascular Outcomes and Inflammation In Esrdmentioning

confidence: 82%

End-Stage Renal Disease, Inflammation and Cardiovascular Outcomes

Dai

Gołembiewska

Lindholm

et al. 2017

Contributions to Nephrology

146

111

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Despite marked improvements in renal replacement therapy during the last 30 years, the age-adjusted mortality rate in end-stage renal disease (ESRD) patients is still unacceptably high and comparable to that of many malignancies. Cardiovascular disease (CVD) remains the major cause of morbidity and mortality in ESRD patients. However, traditional risk factors can only partially explain the high premature cardiovascular burden in this population. Nontraditional risk factors, including persistent low-grade inflammation, are critical in the pathogenesis of atherosclerosis, vascular calcification, and other causes of CVD and may also contribute to protein-energy wasting and other complications in chronic kidney disease (CKD) patients. Inflammatory biomarkers, such as high sensitivity C-reactive protein and interleukin-6, independently predict mortality in these patients. The causes of inflammation in CKD are multifactorial and include imbalance between increased production (due to multiple sources of inflammatory stimuli such as oxidative stress, acidosis, volume overload, co-morbidities, especially infections, genetic and epigenetic influences, and the dialysis procedure) and inadequate removal (due to decreased glomerular filtration rate or in ESRD patients, inadequate dialytic clearance) of pro-inflammatory cytokines. Though there are currently no established guidelines for the treatment of low-grade inflammation in ESRD patients, several strategies have been proposed, such as lifestyle modifications, pharmacological treatment, and optimization of dialysis. Further studies on pathways involved in pathogenic processes of inflammation in ESRD, and long-term effects of anti-inflammatory interventions targeting production or removal of cytokines or both on premature CVD and clinical outcomes in this patient group are warranted.

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Section: Cardiovascular Outcomes and Inflammation In Esrdmentioning

confidence: 82%

End-Stage Renal Disease, Inflammation and Cardiovascular Outcomes

Dai

Gołembiewska

Lindholm

et al. 2017

Contributions to Nephrology

146

111

View full text Add to dashboard Cite

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“…The serum creatinine levels and body weight were positively correlated in the present study ( r = 0.48, P < 0.001). It is well known that malnutrition is associated with a poor prognosis of Malnutrition‐Inflammation‐Atherosclerosis (MIA) syndrome, and our results indicate that serum creatinine levels are a negative predictor of prognosis and might be consistent with the poor prognosis of the malnutrition status.…”

Section: Discussionmentioning

confidence: 99%

“…The reason for this finding has been considered to be that serum phosphorus levels are decreased due to a poor nutritional status rather than a direct influence of low phosphorus levels. Thus, it has been understood that dialysis patients with malnutrition, fraility, and sarcopenia were considered to be a very poor prognostic group. The discrepancy of the results of the present study and the previous report is analogized to the result of the daily staggering efforts to maintain electrolyte management at each hemodialysis facility.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, 4807 of these patients at 58 facilities were enrolled in this study from January to December 2011. We have conducted an annual survey of dialysis facilities since 2012, and papers based on these surveys have been published . Year‐end questionnaires are sent to all dialysis facilities in Kumamoto.…”

Section: Methodsmentioning

confidence: 99%

“…In Japan, kidney transplantations are not performed as frequently as in western countries, and the majority of patients with end‐stage renal disease undergo hemodialysis. The number of hemodialysis patients might increase worldwide due to the progress of developing countries, and because the mortality of hemodialysis patients is relatively high, the risk stratification of mortality might be very important …”

Section: Introductionmentioning

confidence: 99%

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Associations between corrected serum calcium and phosphorus levels and outcome in dialysis patients in the Kumamoto Prefecture

Sueta

Tabata

Tanaka

et al. 2020

Hemodialysis International

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Introduction: Mortality in hemodialysis patients is relatively high; thus, its risk stratification is very important. There are insufficient data describing the current status of the management of serum phosphate and calcium levels. Methods:We conducted a multicenter, prospective, registry study throughout the Kumamoto Prefecture in Japan. We enrolled 1993 patients at 58 facilities with complete explanatory data, including serum phosphate, corrected calcium, and intact parathyroid hormone levels. We categorized subjects into nine categories according to low, normal, and high levels of phosphate and corrected calcium levels. The endpoint was all-cause mortality.Results: Of the total number of subjects, 56.1% of the patients were in the normal phosphate and calcium category, and 72% and 77.1% had controlled serum phosphate and calcium levels, respectively. Two hundred twenty-six deaths occurred during the follow-up period. In the nine categories, the highest mortality rates were observed in the highest corrected calcium and lowest phosphate categories. Stepwise backward multivariate regression analyses identified the serum corrected calcium level (OR, 1.38; 95% CI, 1.06-1.79; P = 0.016) and the serum phosphate level (OR, 1.26; 95% CI, 1.08-1.48; P = 0.003) as significant and independent predictors of all-cause mortality. Conclusions:The corrected serum calcium and phosphate levels are associated with mortality in our dialysis population, with poorest survival in patients with high corrected serum calcium and low serum phosphorus.

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