Nephrol Dial Transplant (2000) 15: 953-960
© 2000 European Renal Association-European Dialysis and Transplant Association
Invited Comment
Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome)
Divisions of Renal Medicine and 1 Baxter Novum, Department of Clinical Science and Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden and 2 Division of Nephrology, Department of Medicine, University of California, Davis and 3 Department of Veterans Affairs Medical Center, Mather, CA, USA
Introduction
It is believed that malnutrition is common in patients with chronic renal failure (CRF). They have reduced body weight, depleted energy (fat tissue) stores, loss of somatic protein (low muscle mass) and low levels of serum albumin, transferrin, pre-albumin and other visceral proteins. Various studies show signs of malnutrition in 23–76% of haemodialysis (HD) and 18–50% of peritoneal dialysis (PD) patients [1–4]. Such variations in the prevalence of malnutrition may be related to factors such as age, case mix, co-morbid conditions and quality of dialysis therapy. The aetiology of malnutrition in CRF is complex and may include many factors, e.g. poor food intake because of anorexia, nausea and vomiting due to uraemic toxicity, hormonal derangements, acidosis and increased resting energy expenditure.
While malnutrition by definition is caused by poor nutritional intake, laboratory or anthropometric measurements are generally used to define it clinically. Other factors can cause
Assessment of malnutrition in CRF
Protein and energy requirements in chronic renal failure
Hypoalbuminaemia as a marker of malnutrition and mortality
Pro-inflammatory cytokines cause malnutrition and cardiovascular disease
Inflammation increases resting energy expenditure
Increased oxidative stress in malnourished and inflamed patients
Inflammation is associated with endothelial dysfunction
CHF may cause wasting in dialysis patients
Relationship between malnutrition, inflammation and cardiovascular disease
Are there two types of malnutrition in dialysis patients?
Nutritional support in uraemic patients with malnutrition
New treatment strategies are needed
Conclusions
Acknowledgments
Notes
References
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