engleski

Nonalcoholic fatty liver disease (NAFLD) - new factor that interplay between inflammation, malnutrition and atherosclerosis in elderly hemodialysis patients

In recent decade, in most regions of the world, an increasing number of adults aged 65 years or more are started on renal replacement therapy each year. In contrast to general population where over-nutrition or obesity is associated with increased cardiovascular risk (CVD), in patients that are on maintained hemodialysis (HD) malnutrition or malnutrition- inflammation complex is associated with poor outcome. In recent years, non-alcoholic fatty liver disease (NAFLD) has been considered to be the liver manifestation of metabolic syndrome (MS) and its development is strongly associated with all components of MS (arterial hypertension, dyslipidemia, obesity and diabetes mellitus type 2) in the general population. The primary endpoint of this study was to determine the patient’s survival due to nutritional and inflammatory state and presence or absence of NAFLD. The second endpoint of this analysis was to investigate the association among NAFLD and various clinical and laboratory data regarding nutritional and inflammatory state of our elderly HD patients. Using a single centre, prospective cohort study design, we followed the progress of 76 patients that are ≥65 and were treated with chronic HD for at least 6 months at the Department of Nephrology, Dialysis and Transplantation. All patients were followed for a minimum of 18 months or until death. Survival was defined as the time from study initiation to death (or end of study, if still alive). The main findings of our study are remarkable positive correlation between NAFLD and hs-CRP (r=0.659 ; p<0.0001) and consequently negative correlation with nutritional parameter ; serum albumin (r= -0.321 ; p=0.004). Interestingly, we have shown that in contrast to general population where NAFLD is associated with obesity, in the present study there were no any statistically significant association among NAFLD and over-nutrition in elderly HD patients. Furthermore, the presence of NAFLD, low serum albumin levels and high hs-CRP were strong predictors of poor outcome in our elderly dialysis patients. Our results indicated that NAFLD probably interplay between inflammation, malnutrition and atherosclerosis in elderly dialysis patients. NAFLD could be a new factor that contributes to type two of malnutrition in elderly HD patients that may be amenable to adequate nutritional and dialysis support.

hemodialysis; elderly; malnutrition; nonalcoholic fatty liver disease

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