Clinical significance of the malnutrition-inflammation-atherosclerosis syndrome in the patients on maintenance hemodialysis

摘要

Objectives. To evaluate the clinical significance of the Malnutrition-Inflammation-Atherosclerosis (MIA) syndrome as a cardiovascular risk factor in the maintenance hemodialysispatients. Patients and Methods. 208 maintenance hemodialysis patients were assessedat the Nephrology and Dialysis Department of the University Clinical Hospital Rijeka.A total of 168 patients were analyzed. The diagnosis of MIA syndrome was established usingthe MIA score assessed with appropriate scale and it was present in 66 patients. Two-yearmortality and morbidity was followed according to presence of MIA syndrome. Patientswith MIA syndrome were randomized into 4 groups and treated with atorvastatin, onlinehemodiafiltation (OL-HDF), Helixone? membrane, and standard hemodialysis. The MIA syndromeparameters were evaluated after follow-uP of 12 and 24 months. A statistical analysiswas performed using the appropriate tests using the statistical software MedCalc 7.5 (Med-Calc, Mariakerke, Belgium). Results. Mean patients age was 63±13 years with equal genderdistribution. The most common underlying renal disease was chronic glomerulonephritis (31.0 %). The MIA syndrome was present in 39.3 % of patients.Their mortality was significantly higher (36.4 % vs.12.7 %, P = 0.0006). Causes of death did not differ accordingto the presence of MIA syndrome. The most common causeof death was cardiovascular disease (62.2 %). The patientstreated with atorvastatin, OL-HDF and Helixone? membranehad better survival than patients treated with standard hemodialysis(P = 0.0032). Independent mortality predictors inthe patients with MIA syndrome were not found. Treatmentwith atorvastatin and OL-HDF significantly reduced serum Creactiveprotein levels (P = 0.0161; P = 0.0425) and seruminterleukin-6 levels (P = 0.0005; P = 0.021) after 12 and 24months, respectively. Conclusion. Atorvastatin, OL-HDF anduse of the new Helixone? membrane was beneficial in thetreatment of patients with MIA syndrome.