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NDT Advance Access originally published online on July 6, 2004
Nephrology Dialysis Transplantation 2004 19(9):2181-2183; doi:10.1093/ndt/gfh296
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Nephrol Dial Transplant Vol. 19 No. 9 © ERA-EDTA 2004; all rights reserved


Personal Opinion

Wasting, but not malnutrition, predicts cardiovascular mortality in end-stage renal disease

Peter Stenvinkel, Olof Heimbürger and Bengt Lindholm

Department of Renal Medicine and Baxter Novum, Karolinska Institutet, Karolinska University Hospital at Huddinge, Stockholm, Sweden

Correspondence and offprint requests to: Peter Stenvinkel, MD, PhD, Division of Renal Medicine K56 St, Karolinska University Hospital, Huddinge, S-141 86 Stockholm, Sweden. Email: peter.stenvinkel@klinyet.ki.se

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Beddhu et al. [1] recently have reported that there were no positive associations of malnutrition with documented acute coronary syndromes requiring hospitalization in a large incident Medicare dialysis population. The authors state that their findings do not support our suggestion [2] of an association between malnutrition, inflammation and atherosclerosis (MIA hypothesis) in patients with end-stage renal disease (ESRD). No doubt the study by Beddhu et al. [1] is a well performed study conducted in a large group of dialysis patients. However, we feel that some fundamental issues regarding the nomenclature and definition of ‘malnutrition’ need to be discussed. First, as discussed by Mitch [3], the use of the word ‘malnutrition’ has often been used incorrectly in the renal literature, and, according to Mitch, ‘malnutrition’ should be used to describe a deficient nutritional status caused by insufficient nutritient intake. However, . . . [Full Text of this Article]


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