Malnutrition-inflammation complex syndrome in dialysis patients: causes and consequences.
By Kamyar Kalantar-Zadeh, T. Ikizler, Gladys Block, M. Avram, J. Kopple. American Journal of Kidney Diseases, 2003
1,028 citations recorded by the source corpus.
Protein-energy malnutrition (PEM) and inflammation are common and usually concurrent in maintenance dialysis patients. Many factors that appear to lead to these 2 conditions overlap, as do assessment tools and such criteria for detecting them as hypoalbuminemia. Both these conditions are related to poor dialysis outcome. Low appetite and a hypercatabolic state are among common features. PEM in dialysis patients has been suggested to be secondary to inflammation; however, the evidence is not conclusive, and an equicausal status or even opposite causal direction is possible. Hence, malnutrition-inflammation complex syndrome (MICS) is an appropriate term. Possible causes of MICS include comorbid illnesses, oxidative and carbonyl stress, nutrient loss through dialysis, anorexia and low nutrient intake, uremic toxins, decreased clearance of inflammatory cytokines, volume overload, and dialysis-related factors. MICS is believed to be the main cause of erythropoietin hyporesponsiveness, high rate of cardiovascular atherosclerotic disease, decreased quality of life, and increased mortality and hospitalization in dialysis patients. Because MICS leads to a low body mass index, hypocholesterolemia, hypocreatininemia, and hypohomocysteinemia, a "reverse epidemiology" of cardiovascular risks can occur in dialysis patients. Therefore, obesity, hypercholesterolemia, and increased blood levels of creatinine and homocysteine appear to be protective and paradoxically associated with a better outcome. There is no consensus about how to determine the degree of severity of MICS or how to manage it. Several diagnostic tools and treatment modalities are discussed. Successful management of MICS may ameliorate the cardiovascular epidemic and poor outcome in dialysis patients. Clinical trials focusing on MICS and its possible causes and consequences are urgently required to improve poor clinical outcome in dialysis patients.
Subfields: Hematology, Nephrology, Surgery
View Paper: https://www.semanticscholar.org/paper/2856f462ead4d987df18c0be736e94c621aa27c3
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Citations in the corpus
- Appetite and inflammation, nutrition, anemia, and clinical outcome in hemodialysis patients. (2004, background): “It may be the missing link between inflammation and PEM and contributes to the development of the reverse epidemiology phenomenon (5, 17).”
- A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. (2008, background): “These syndromes have been referred to as uremic malnutrition,(10,11) uremic (renal) cachexia, protein–energy malnutrition, malnutrition–inflammation atherosclerosis syndrome, or malnutrition–inflammation complex (or cachexia) syndrome.(9,22) In the last 5 years, it has become apparent that many of t”
- Survival advantages of obesity in dialysis patients. (2005, background): “Because both PEM and inflammation are strongly associated with each other and can change many nutritional measures in the same direction, and because the relative contributions of measures of these 2 conditions to each other and to outcomes in maintenance dialysis patients are not yet well defined, ”