Malnutrition, Inflammation, and Atherosclerosis in Peritoneal Dialysis Patients

Abstract

The clinical outcomes of peritoneal dialysis (PD) patients and the ongoing health and function of the peritoneum obviously depend on a number of genetic and non genetic systemic factors. During the last two decades, much of the emphasis in PD and in hemodialysis (HD) has been on improving dialysis adequacy, especially with regard to small-solute removal. That factor is definitely of importance to improved clinical outcomes, but systemic factors—such as the various nutrition, immunologic, and cardiovascular abnormalities in uremia, often aggravated by an underlying disease—are increasingly being recognized as even more important determinants of outcomes. Thus, the focus is now shifting from “dialysology” to studies of the pathophysiology of uremia and its complications. In this brief review, we focus on the so-called MIA syndrome (malnutrition, inflammation, and atherosclerosis), because the presence of this syndrome has a dramatic effect on patient survival as well as on the health and function of the peritoneum.