[Inflammation and nutritional status in haemodialysis patients].Med Pregl. 2007; 60 Suppl 2:137-41.MP
Protein-calorie malnutrition is highly prevalent in patients with end-stage renal disease and hypoalbuminemia is considered the best clinical marker of malnutrition and mortality in this population. Recently, it has been recognized that inflammation may be also as important as protein intake in causing hypoalbuminemia. The aim of this study is to investigate the relationship between nutritional status, serum albumin concentration and C-reactive protein in patients on regular hemodialysis.
MATERIAL AND METHODS
We performed subjective global assessment, anthropometric and laboratory measurements to evaluate nutritional and inflammatory status in 43 hemodialysis patients (27 M, 16 F, mean age 57.7+/-12.7 years).
According to SGA, malnutrition was present in 46.5% patients on haemodialysis. By univariate logistic regression analysis, triceps skinfold, mid-arm muscle circumference, body fat %, lean body mass, body-mass index, total proteins, albumin, haemoglobin, creatinine, cholesterol, fibrinogen and CRP were shown to be associated with malnutrition (SGA 2-4). During multivariate analysis, BMI (p=0.011) and CRP (p=0.018) remained associated with malnutrition. In multiple regression models, the mean value of serum albumin concentration was explained (R=0.785, p=0.01) by CRP (r=-0.474; p<0.001), BMI (r=0.297: p=0.008) and total proteins (r=0.288; p=0.013).
DISCUSSION AND CONCLUSION
The results suggested that malnutrition and chronic inflammation are important determinants of hypoalbuminemia. There is a complex cause and effect relationship between inflammation and nutritional status. Novel strategies aimed at attenuating the adverse nutritional effects of chronic inflammatory response may improve the clinical outcome in hemodialysis patients.