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Recent advances in understanding the malnutrition-inflammation-cachexia syndrome in chronic kidney disease patients: What is next?
Semin Dial. 2005 Sep-Oct; 18(5):365-9.SD

Abstract

Several recent clinical trials using single modalities to correct the conventional cardiovascular risk factors in patients with chronic kidney disease (CKD) or to improve dialysis dose and techniques in maintenance dialysis patients have failed despite the high rate of cardiovascular mortality in these individuals. Protein-energy malnutrition and inflammation, two relatively common and concurrent conditions in CKD patients, have been implicated as the main cause of poor short-term survival in this population. The "malnutrition-inflammation-cachexia syndrome" (MICS) appears to be the main cause of worsening atherosclerotic cardiovascular disease in the CKD population. The MICS is associated with low serum cholesterol and homocysteine levels and leads to "cachexia in slow motion." Hence a reverse epidemiology of cardiovascular risk factors is observed in dialysis patients with a paradoxical association of obesity, hypercholesterolemia, and hyperhomocysteinemia with better survival. Correction of MICS can potentially ameliorate the cardiovascular epidemic in CKD patients. Because MICS is multifactorial, its correction will require an integral approach rather than a single intervention. The ongoing obsession with conventional cardiovascular risk factors largely reflecting overnutrition in a population that suffers from the short-term consequences of undernutrition and excessive inflammation may well be fruitless. Clinical trials focusing on the causes and consequences of MICS and its modulation using nutritional interventions may be the key to improving survival in these individuals.

Authors

No affiliation info available

Pub Type(s)

Editorial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Review

Language

eng

PubMed ID

16191172

Citation

Kalantar-Zadeh, Kamyar. "Recent Advances in Understanding the Malnutrition-inflammation-cachexia Syndrome in Chronic Kidney Disease Patients: what Is Next?" Seminars in Dialysis, vol. 18, no. 5, 2005, pp. 365-9.
Kalantar-Zadeh K. Recent advances in understanding the malnutrition-inflammation-cachexia syndrome in chronic kidney disease patients: What is next? Semin Dial. 2005;18(5):365-9.
Kalantar-Zadeh, K. (2005). Recent advances in understanding the malnutrition-inflammation-cachexia syndrome in chronic kidney disease patients: What is next? Seminars in Dialysis, 18(5), 365-9.
Kalantar-Zadeh K. Recent Advances in Understanding the Malnutrition-inflammation-cachexia Syndrome in Chronic Kidney Disease Patients: what Is Next. Semin Dial. 2005 Sep-Oct;18(5):365-9. PubMed PMID: 16191172.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recent advances in understanding the malnutrition-inflammation-cachexia syndrome in chronic kidney disease patients: What is next? A1 - Kalantar-Zadeh,Kamyar, PY - 2005/9/30/pubmed PY - 2006/5/6/medline PY - 2005/9/30/entrez SP - 365 EP - 9 JF - Seminars in dialysis JO - Semin Dial VL - 18 IS - 5 N2 - Several recent clinical trials using single modalities to correct the conventional cardiovascular risk factors in patients with chronic kidney disease (CKD) or to improve dialysis dose and techniques in maintenance dialysis patients have failed despite the high rate of cardiovascular mortality in these individuals. Protein-energy malnutrition and inflammation, two relatively common and concurrent conditions in CKD patients, have been implicated as the main cause of poor short-term survival in this population. The "malnutrition-inflammation-cachexia syndrome" (MICS) appears to be the main cause of worsening atherosclerotic cardiovascular disease in the CKD population. The MICS is associated with low serum cholesterol and homocysteine levels and leads to "cachexia in slow motion." Hence a reverse epidemiology of cardiovascular risk factors is observed in dialysis patients with a paradoxical association of obesity, hypercholesterolemia, and hyperhomocysteinemia with better survival. Correction of MICS can potentially ameliorate the cardiovascular epidemic in CKD patients. Because MICS is multifactorial, its correction will require an integral approach rather than a single intervention. The ongoing obsession with conventional cardiovascular risk factors largely reflecting overnutrition in a population that suffers from the short-term consequences of undernutrition and excessive inflammation may well be fruitless. Clinical trials focusing on the causes and consequences of MICS and its modulation using nutritional interventions may be the key to improving survival in these individuals. SN - 0894-0959 UR - https://www.unboundmedicine.com/medline/citation/16191172/Recent_advances_in_understanding_the_malnutrition_inflammation_cachexia_syndrome_in_chronic_kidney_disease_patients:_What_is_next L2 - https://doi.org/10.1111/j.1525-139X.2005.00074.x DB - PRIME DP - Unbound Medicine ER -