engleski

Clinical Significance Of The Malnutrition-Inflammation-Atherosclerosis Syndrome In The Patients On Maintenance Hemodialysis

Objectives. To evaluate a clinical significance of the Malnutrition-Inflammation-Atherosclerosis (MIA) syndrome as a cardiovascular risk factor in the maintenance hemodialysis patients. Patients and Methods. 208 maintenance hemodialysis patients were assessed in the period from June 2005 to June 2007 at 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 using the MIA score assessed with appropriate scale and it was positive in 66 patients. Two-year mortality and morbidity were followed according to presence of MIA syndrome. Patients with MIA syndrome were randomized into four groups and treated with atorvastatin, online hemodiafiltration (OL-HDF), Helixone® ; membrane, and standard hemodialysis. The MIA syndrome parameters were evaluated after follow-up of 12 and 24 months. A statistical analysis was performed using the appropriate tests using the statistical software MedCalc 7, 5 (MedCalc, Mariakerke, Belgium). Results. Mean patients age was 6313 years with equal gender distribution. 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 according to the presence of MIA syndrome. The most common cause of death was cardiovascular disease (62, 2%), particularly myocardial infarction (24, 3%). Basal clinical and laboratory data of the patients with MIA syndrome at the time of randomization were similar. The patients treated with atorvastatin, OL-HDF and Helixone® ; membrane had better survival than patients treated with standard hemodialysis (P=0, 0032). Independent mortality predictors in the patients with MIA syndrome were not found but MIA score was almost significant (P=0, 0681). Treatment with atorvastatin and OL-HDF significantly reduced serum C-reactive protein levels (P=0, 0161 ; P=0, 0425), and serum interleukin-6 levels (P=0, 0005 ; P=0, 021) after 12 and 24 months, respectively. Treatment with OL-HDF showed beneficial effect on anemia treatment (P=0, 0049) as well as significantly reduced serum triglyceride levels (P=0, 042). Treatment with atorvastatin was also beneficial regarding the influence on the serum triglyceride levels (P=0, 0049), and was safe without significant side effects. Conclusion. Atorvastatin, OL-HDF and use of the new Helixone® ; membrane were beneficial in the treatment of patients with MIA syndrome. Trial registration number: ISRCTN61950442

Atherosclerosis; Atorvastatin; Cardiovascular; diseases; Cytokines; Hemodialysis; Inflammation; Malnutrition; MIA syndrome; Online hemodiafiltration

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