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Nephrol Dial Transplant (2000) 15: 1521-1524
© 2000 European Renal Association-European Dialysis and Transplant Association

Editorial Comments

Malnutrition and the acute-phase reaction in dialysis patients—how to measure and how to distinguish

George A. Kaysen

Division of Nephrology, Department of Medicine University of California Davis, and the Department of Veterans' Affairs Northern California Health Care System, Davis and Mather, CA, USA

Predictors of mortality in dialysis patients

Mortality of patients with end-stage renal disease (ESRD) remains a significant problem, with most deaths resulting from cardiovascular disease [1]. Several of the most powerful predictors of mortality in cross-sectional studies are what are regarded as nutritional markers; most notably serum albumin and serum creatinine [2], respectively markers of visceral and skeletal protein mass. Prealbumin (transthyretin), a further nutritionally regulated protein [3,4] also powerfully predicts mortality both in peritoneal [5,6] and haemodialysis patients [5]. These observations have been used to support a hypothesis that malnutrition is the proximate cause of mortality. Such a hypothesis would suggest that we could feed our way out of morbidity and mortality in our patient population. Unfortunately we have been unable to do so. Why have we failed and where shall we go?

Malnutrition and inflammation cause similar changes in ‘nutritional’ measures

. . . [Full Text of this Article]

Inflammation predicts vascular disease

How to appraise inflammation and malnutrition in the presence of the other

Source of inflammation

Acknowledgments

Notes

References


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