Malnutrition-inflammation Complex Syndrome Research Articles

A simple score for malnutrition-inflammation complex syndrome (MICS) is associated with the risk of mortality in Japanese patients undergoing maintenance hemodialysis.

Malnutrition-inflammation complex syndrome (MICS) is highly prevalent in patients undergoing hemodialysis. We determined the prognostic value of the Simple MICS score, calculated using a combination of age, body mass index, and serum concentrations of albumin, creatinine, and C-reactive protein. We retrospectively recruited 218 Japanese patients undergoing maintenance hemodialysis. The primary outcome was all-cause mortality, and the main exposure was the Simple MICS score. Cox proportional hazard regression analysis and logistic regression analysis were used to characterize the relationship between the Simple MICS score and mortality. During a median 4.4-year follow-up period, 56 patients died. Multivariable-adjusted models showed that a higher Simple MICS score was associated with higher risks of mortality. The predictability for all-cause mortality of the Simple MICS score was significantly better than conventional nutrition-related indices. The Simple MICS score can be used to stratify mortality risk in patients undergoing maintenance hemodialysis.

Salivary lipid mediators: Key indexes of inflammation regulation in heart failure disease.

Cardiovascular diseases (CVDs) are the leading cause of premature death and disability in humans and their incidence continues to increase. Oxidative stress and inflammation have been recognized as key pathophysiological factors in cardiovascular events. The targeted modulation of the endogenous mechanisms of inflammation, rather than its simple suppression, will become key in treating chronic inflammatory diseases. A comprehensive characterization of the signalling molecules involved in inflammation, such as endogenous lipid mediators, is thus needed. Here, we propose a powerful MS-based platform for the simultaneous quantitation of sixty salivary lipid mediators in CVD samples. Saliva, which represents a non-invasive and painless alternative to blood, was collected from patients suffering from acute and chronic heart failure (AHF and CHF, respectively), obesity and hypertension. Of all the patients, those with AHF and hypertension showed higher levels of isoprostanoids, which are key indexes of oxidant insult. Compared to the obese population, AHF patients showed lower levels (p<0.02) of antioxidant omega-3 fatty acids, in line with the "malnutrition-inflammation complex syndrome" typical of HF patients. At hospital admission, AHF patients showed significantly higher levels (p<0.001) of omega-3 DPA and lower levels (p<0.04) of lipoxin B4 than CHF patients, suggesting a lipid rearrangement typical of the failing heart during acute decompensation. If confirmed, our results highlight the potential use of lipid mediators as predictive markers of re-acutisation episodes, thus providing opportunities for preventive intervention and a reduction in hospitalizations.

QEEG characteristics associated with malnutrition-inflammation complex syndrome.

End-stage renal disease (ESRD) has been linked to cerebral complications due to the comorbidity of malnutrition and inflammation, which is referred to as malnutrition-inflammation complex syndrome (MICS). The severity of this condition is clinically assessed with the malnutrition-inflammation score (MIS), and a cutoff of five is used to optimally distinguish patients with and without MICS. However, this tool is still invasive and inconvenient, because it combines medical records, physical examination, and laboratory results. These steps require clinicians and limit MIS usage on a regular basis. Cerebral diseases in ESRD patients can be evaluated reliably and conveniently by using quantitative electroencephalogram (QEEG), which possibly reflects the severity of MICS likewise. Given the links between kidney and brain abnormalities, we hypothesized that some QEEG patterns might be associated with the severity of MICS and could be used to distinguish ESRD patients with and without MICS. Hence, we recruited 62 ESRD participants and divided them into two subgroups: ESRD with MICS (17 women (59%), age 60.31 ± 7.79 years, MIS < 5) and ESRD without MICS (20 women (61%), age 62.03 ± 9.29 years, MIS ≥ 5). These participants willingly participated in MIS and QEEG assessments. We found that MICS-related factors may alter QEEG characteristics, including the absolute power of the delta, theta, and beta 1 bands, the relative power of the theta and beta 3 subbands, the coherence of the delta and theta bands, and the amplitude asymmetry of the beta 1 band, in certain brain regions. Although most of these QEEG patterns are significantly correlated with MIS, the delta absolute power, beta 1 amplitude asymmetry, and theta coherence are the optimal inputs for the logistic regression model, which can accurately classify ESRD patients with and without MICS (90.0 ± 5.7% area under the receiver operating characteristic curve). We suggest that these QEEG features can be used not only to evaluate the severity of cerebral disorders in ESRD patients but also to noninvasively monitor MICS in clinical practice.

Malnutrition-Inflammation complex syndrome in Libyan patients with end-Stage renal disease at Hun-Aljufrah

Malnutrition and inflammation complex syndrome in ESRD Patients on maintenance Hemodialysis therapy remains the most common cause of morbidity and mortality characterized by alteration in the structural and functional ability of plasma proteins. The aim of this study was to assess the serum level of albumin, BMI and hs-CRP as a marker of Malnutrition-Inflammation Complex Syndrome. This is a case-control study conducted at Alafia Hospital Hun-Aljufrah from December 2014 to December 2015. Libyan patients with ESRD who routinely attend to dialysis center at the above-mentioned hospital during the period of the study were randomly recruited for this study. The study included one hundred ESRD and one hundred age and sexmatched healthy controls. The patients’ information such as age, sex, height, weight, and clinical history were recorded. Blood samples (6 ml) were collected from patients in plain and EDTA containers from which EDTA and Serum samples were separated. The results of our study showed that there were significant decrease in the mean serum level of albumin (3.12±0.39) (p. value=0.000) and BMI (20.3±5.5) (p. value=0.000) as well as significant increase in the mean serum level of serum C-reactive protein (20.13±5.704) (p. value=0.000) in case group when compared to the control group. The DOT Blot Correlation test showed that there was a significant negative correlation between hs-CRP with albumin (r= -0.812, p=0.02). In conclusion, the significant decreased in the mean level of serum albumin and BMI, as well as the significant increase in the mean level of serum C-reactive protein among hemodialysis ESRD patients, might place them at risk of developing Malnutrition-Inflammation Complex Syndrome in the future. The significant negative correlation between serum albumin with hsCRP support the facts systemic inflammation is the main cause of malnutrition and cardiovascular disease in ESRD patient.

Malnutrition-Inflammation Complex Syndrome and Bone Fractures and Cardiovascular Disease Events in Patients Undergoing Hemodialysis: The Q-Cohort Study

Rationale & ObjectiveMalnutrition-inflammation complex syndrome (MICS) is common in patients receiving hemodialysis and increases the risks of morbidity and mortality. However, few studies have examined the overall impact of MICS on disorders of the bone-cardiovascular axis.Study DesignProspective, multicenter, observational cohort study.Setting & ParticipantsA total of 3,030 patients receiving maintenance hemodialysis registered in the Q-Cohort Study.PredictorsA newly developed score for MICS composed of elements chosen from 8 baseline parameters related to nutrition and inflammation by bootstrap resampling, multivariable-adjusted Cox proportional hazard risk analysis for all-cause mortality, and the risk prediction rule. β-coefficients of each element analyzed in the multivariable-adjusted model were used for the creation of the MICS score.OutcomesBone fractures, cardiovascular disease events, and the composite outcome of bone fractures and cardiovascular disease events.Analytical ApproachCox proportional hazard regression and Fine-Gray proportional subdistribution hazards regression.ResultsDuring a median follow-up of 4 years, 140 patients developed bone fractures and 539 developed cardiovascular disease events. Age; serum levels of creatinine, albumin, and C-reactive protein; and body mass index were selected for the creation of the MICS score. The median (IQR) MICS score was 196 (181-212). The multivariable-adjusted Cox proportional hazard risk model and the competing risk model showed that a higher MICS score was incrementally associated with elevated risks of bone fractures, cardiovascular disease events, and the composite outcome; hazard risks (95% CIs) of fractures, cardiovascular disease events, and the composite outcome for each 10-point increase in the MICS score were 1.18 (1.01-1.38), 1.16 (1.07-1.26), and 1.15 (1.07-1.24), respectively.LimitationsOne-time measurement of the parameters used for the creation of the MICS score.ConclusionsMalnutrition and inflammation represented by the MICS score were associated with increased risks of bone-cardiovascular axis disorders in patients receiving maintenance hemodialysis.

EEG Delta/Theta Ratio and Microstate Analysis Originating Novel Biomarkers for Malnutrition-Inflammation Complex Syndrome in ESRD Patients.

The Malnutrition-Inflammation Score (MIS) was initially proposed to evaluate malnutrition-inflammation complex syndrome (MICS) in end-stage renal disease (ESRD) patients. Although MICS should be routinely evaluated to reduce the hospitalization and mortality rate of ESRD patients, the inconvenience of the MIS might limit its use. Cerebral complications in ESRD, possibly induced by MICS, were previously assessed by using spectral electroencephalography (EEG) via the delta/theta ratio and microstate analysis. Correspondingly, EEG could be used to directly assess MICS in ESRD patients, but the relationships among MICS and these EEG features remain inconclusive. Thus, we aimed to investigate the delta/theta ratio and microstates in ESRD patients with high and low risks of MICS. We also attempted to identify the correlation among the MIS, delta/theta ratio, and microstate parameters, which might clarify their relationships. To achieve these objectives, a total of forty-six ESRD subjects were willingly recruited. We collected their blood samples, MIS, and EEGs after receiving written informed consent. Sixteen women and seven men were allocated to low risk group (MIS ≤ 5, age 57.57 ± 14.88 years). Additionally, high risk group contains 15 women and 8 men (MIS > 5, age 59.13 ± 11.77 years). Here, we discovered that delta/theta ratio (p < 0.041) and most microstate parameters (p < 0.001) were significantly different between subject groups. We also found that the delta/theta ratio was not correlated with MIS but was strongly with the average microstate duration (ρ = 0.708, p < 0.001); hence, we suggested that the average microstate duration might serve as an alternative encephalopathy biomarker. Coincidentally, we noticed positive correlations for most parameters of microstates A and B (0.54 ≤ ρ ≤ 0.68, p < 0.001) and stronger negative correlations for all microstate C parameters (−0.75 ≤ ρ ≤ −0.61, p < 0.001). These findings unveiled a novel EEG biomarker, the MIC index, that could efficiently distinguish ESRD patients at high and low risk of MICS when utilized as a feature in a binary logistic regression model (accuracy of train-test split validation = 1.00). We expected that the average microstate duration and MIC index might potentially contribute to monitor ESRD patients in the future.

Malnutrition-Inflammation Complex Syndrome: A Cause of Low Parathyroid Hormone in Patients With Chronic Kidney Disease

Secondary hyperparathyroidism is commonly seen in patients with chronic kidney disease (CKD) due to hypocalcemia, hyperphosphatemia and low vitamin D levels and is associated with high-turnover bone disease. In contrast, some patients with advanced CKD, including those requiring dialysis (end-stage renal disease [ESRD]), develop adynamic bone disease with features of low-turnover bone disease. Low serum parathyroid hormone (PTH) has been used as a biochemical marker of adynamic bone disease. Low PTH levels may not necessarily be due to adynamic bone disease but could be a manifestation of the malnutrition inflammation complex syndrome (MICS). The optimal management of hypoparathyroidism associated with MICS is not well known. Currently, there is insufficient evidence to suggest if there is any role in improving nutritional and inflammatory status among patients with CKD and MICS. Furthermore, it also remains unclear whether these changes will help address low PTH levels seen in these patients. We report three patients with advanced CKD who had very low PTH levels possibly attributed to MICS. In addition, we briefly discuss other characteristics and pathophysiology of MICS.

Importance of Variability Pattern Analysis for Malnutrition Information Score to Improve Treatment of Chronic Kidney Disease

Background: Morbidity and mortality envisaged by chronic kidney disease (CKD) remains a health menace throughout the world. Complications, incidence, prevalence, the impact of dietary recommendations, risk factors, outcome, and management strategies have not been rationalized due to several adversities resulting in escalated death rates. The objective of this study was to evaluate and establish a malnutrition information score (MIS) as a means of ease of CKD prevention and progression. MIS underlies the consistencies in findings through MIS show higher values can be corroborated to recommend the augmentation parameters in utilizing MICS techniques and other healthcare types of equipments. &#x0D; Methods: A randomized, non-biased sampling of patients presenting to dialysis unit with their maintenance schedule program in the nephrology department of Medical Unit-3 of PIMS, Islamabad were introspected for inclusions. Personal history, BSF thickness and MAC values were measured, and MAMC was calculated by = MAC – (3.1416 x TSF). The study was conducted in the Department of Nephrology, PIMS, Islamabad for a duration of six months.&#x0D; Results: The study conducted across 59 male patients and 33female patients indicate that males are more susceptible to CKD than females as evidenced by clinical stability of 67%. Appetite loss, degree of severity, Co-morbidity, BMI, MIS range, and clinical stability status of 100 study participants show variable indices indicating the stress on personal and family history of the patients. MIS pose as an indicator for determining the apt Malnutrition-Inflammation Complex Syndrome (MICS) and other types of equipments for treating CKD. &#x0D; Conclusion: CKD patients undergoing maintenance hemodialysis analyzed for dietary balance affirm the utility of MIS in determining the MICS and other types of healthcare equipments indirectly in ensuring reduction in morbidity and mortality.

Erythropoietin Resistant Anaemia among Haemodialysis Patients with Malnutrition Inflammation Complex Syndrome in Dar es Salaam, Tanzania

Background: Erythropoietin-resistant anaemia in hemodialysis patients is accompanied by poor outcomes. Malnutrition and inflammation impair effective erythropoiesis through various mechanisms and may cause erythropoietin resistance. In this study, we aimed to determine the effect of malnutrition inflammatory complex on erythropoietin resistance among patients on maintenance hemodialysis at Muhimbili National Hospital in Dar es Salaam, Tanzania. Materials and Methods: This was a hospital-based retrospective cross-sectional study involving 85 patients on maintenance hemodialysis. Participants’ information was collected and recorded in data collection tools; this information included clinical and physical information (body weight and height) and laboratory tests (complete blood count, serum albumin, C-reactive protein, transferrin, total iron, ferritin, and urea). Bodyweight and height were measured and body mass index calculated. Erythropoietin Resistance Index (ERI) was obtained as the weight-adjusted average weekly erythropoietin dose divided by hemoglobin level, while Malnutrition Inflammation Score (MIS) was used to determine Malnutrition Inflammation Complex Syndrome (MICS). Results: Eighty-five participants were recruited for this study, of which 76.5% were males and the mean age was 54.1 ± 13.2 years. MICS was noted in 50.6% participants. The overall mean weight-adjusted ERI of the study population was 20.6 ± 7.7 units/kg per g/dl. Patients with inflammation, MICS, and on long-term hemodialysis had significantly higher mean ERI. On multivariate analysis, ERI significantly correlated with MIS (p &lt;0.01) in a dose-dependent manner. Conclusion: In hemodialysis patients, anaemia resistant to Erythropoietin therapy is linked to malnutrition inflammation complex syndrome. MICS needs to be appropriately treated to achieve target hemoglobin levels.

Chronic Kidney Disease as a Systemic Inflammatory Syndrome: Update on Mechanisms Involved and Potential Treatment.

Chronic kidney disease (CKD) is characterized by manifestations and symptoms involving systemic organs and apparatus, associated with elevated cardiovascular morbidity and mortality, bone disease, and other tissue involvement. Arterial hypertension (AH), diabetes mellitus (DM), and dyslipidemia, with glomerular or congenital diseases, are the traditional risk factors recognized as the main causes of progressive kidney dysfunction evolving into uremia. Acute kidney injury (AKI) has recently been considered an additional risk factor for the worsening of CKD or the development of CKD de novo. Evidence underlies the role of systemic inflammation as a linking factor between AKI and CKD, recognizing the role of inflammation in AKI evolution to CKD. Moreover, abnormal increases in oxidative stress (OS) and inflammatory status in CKD seem to exert an important pathogenetic role, with significant involvement in the clinical management of this condition. With our revision, we want to focus on and update the inflammatory mechanisms responsible for the pathologic conditions associated with CKD, with particular attention on the development of AKI and AKI-CKD de novo, the alteration of calcium-phosphorus metabolism with bone disease and CKD-MBD syndrome, the status of malnutrition and malnutrition–inflammation complex syndrome (MICS) and protein-energy wasting (PEW), uremic sarcopenia, the status of OS, and the different inflammatory pathways, highlighting a new approach to CKD. The depth comprehension of the mechanisms underlying the development of inflammation in CKD may present new possible therapeutic approaches in CKD and hopefully improve the management of correlated morbidities and provide a reduction in associated mortality.

Study of MICS in Hemodialysis Patients and Its Relation with Serum Thyroid Hormones

Background: Malnutrition-inflammation complex syndrome (MICS) is a frequent and serious problem in patients undergoing dialysis with estimated prevalence about 18–75%. The etiology is multifactorial. MICS is believed to be main cause of erythropoietin hyporesponsiveness, low free triiodothyronine (FT3) and increased mortality and hospitalization among the dialysis patients. Objective: To determine the prevalence of MICS and identify association between MICS and thyroid hormones. Patients and Methods: This was cross sectional study, which was conducted on 91 patients admitted at Hemodialysis Units of Zagazig University Hospitals and Fakous General Hospital. Blood samples had been obtained before the initiation of the HD session and after an 8 hours fasting, blood measurements included: Serum urea, creatinine, TSH, T3, FT3 and FT4. Results: This study showed that, prevalence of MICS was about 56%. There was statistically significant difference between patients had MICS and patients without MICS regarding age, and duration of hemodialysis. There was no statistically significant difference between patients had MICS and patients without MICS regarding T3, T4, TSH. There was statistically significant difference between patients had MICS and patients without MICS regarding serum creatinine. Conclusion: This study concluded high prevalence of malnutrition-inflammation complex syndrome on patients on dialysis. There was no association between MICS and thyroid hormones.

Association of lactate dehydrogenase with mortality in incident hemodialysis patients.

Lactate dehydrogenase (LDH) plays a role in the glucose metabolism of the human body. Higher LDH levels have been linked to mortality in various cancer types; however, the relationship between LDH and survival in incident hemodialysis (HD) patients has not yet been examined. We hypothesized that higher LDH level is associated with higher death risk in these patients. We examined the association of baseline and time-varying serum LDH with all-cause, cardiovascular and infection-related mortality among 109 632 adult incident HD patients receiving care from a large dialysis organization in the USA during January 2007 to December 2011. Baseline and time-varying survival models were adjusted for demographic variables and available clinical and laboratory surrogates of malnutrition-inflammation complex syndrome. There was a linear association between baseline serum LDH levels and all-cause, cardiovascular and infection-related mortality in both baseline and time-varying models, except for time-varying infection-related mortality. Adjustment for markers of inflammation and malnutrition attenuated the association in all models. In fully adjusted models, baseline LDH levels ≥360 U/L were associated with the highest risk of all-cause mortality (hazard ratios = 1.19, 95% confidence interval 1.14-1.25). In time-varying models, LDH >280 U/L was associated with higher death risk in all three hierarchical models for all-cause and cardiovascular mortality. Higher LDH level >280 U/L was incrementally associated with higher all-cause and cardiovascular mortality in incident dialysis patients, whereas LDH <240 U/L was associated with better survival. These findings suggest that the assessment of metabolic functions and monitoring for comorbidities may confer survival benefit to dialysis patients.

Prevalence of malnutrition inflammation complex syndrome among patients on maintenance haemodialysis at Muhimbili National Hospital in Tanzania: a cross-sectional study

BackgroundMalnutrition, inflammation, and the combination thereof are predictors of poor outcomes in haemodialysis patients. Malnutrition Inflammation Complex Syndrome (MICS) is an accelerator of atherosclerosis and portends high mortality. Early recognition and treatment of MICS may help to improve the clinical outlook of such patients. This study investigated the prevalence of MICS and its associated factors among patients on maintenance haemodialysis at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania.MethodsThis was a prospective cross-sectional observational study done among 160 adult patients on maintenance haemodialysis at MNH in 2019. All participants provided written informed consent. Questionnaires were used to collect data and patients’ blood was tested for complete blood count (CBC), C-reactive protein (CRP), ferritin, transferrin, creatinine, urea, total cholesterol, and albumin. The Malnutrition Inflammation Score was used to assess MICS and its severity. Data analysis was done using the SPSS 20 software.ResultsOf the 160 patients included in the study, 111 (69.4%) were male. The mean age (±SD) of patients and mean duration (±SD) on haemodialysis were 52.2(13.3) years and 22(18) months respectively. MICS was prevalent in 46.3% (mild in 24.4% and moderate to severe in 21.9%).Long-term haemodialysis (> 4 years) was an independent predictor of MICS [Adjusted Odds Ratio, AOR 5.04 (95% CI: 1.33–19.2), p < 0.05]. Hypercholesterolaemia was a negative predictor of MICS [AOR 0.11 (95% CI: 0.01–0.97), p < 0.05]. Patients with MICS had significantly lower mean body mass index, serum albumin, total cholesterol, transferrin, haemoglobin, and creatinine levels. The presence of MICS was higher in underweight patients and those who had inflammation. Haemodialysis adequacy did not correlate with MICS.ConclusionMalnutrition Inflammation Complex Syndrome is relatively common among patients on haemodialysis in Dar es Salaam, Tanzania. Our study has shown a longer duration on haemodialysis to be associated with the occurrence of MICS; on the contrary, having hypercholesterolaemia seems to be protective against MICS consistent with the concept of reverse epidemiology. Patients on haemodialysis should be assessed regularly for malnutrition and inflammation and should receive appropriate and timely treatment to reduce the burden of associated morbidity, and mortality to these patients.

P1565THE COMBINATION OF MALNUTRITION-INFLAMMATION AND LIMITATIONS IN FUNCTIONAL STATUS IS ASSOCIATED WITH A HIGH RISK OF MORTALITY IN HEMODIALYSIS PATIENTS: RESULTS FROM THE DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY

Abstract Background and Aims The malnutrition-inflammation-complex (MIC) is a risk factor for mortality and lower quality of life in haemodialysis (HD) patients. The identification of MIC and its risk factors, which include the limited ability to perform functional status (FS), is key to improve the patient experience on HD. Our study investigates the association of MIC and FS combinations with mortality in HD patients. Method We analysed data from a cohort of 5465 HD patients from Australia, France, Germany, Italy, Japan, New Zealand, Spain, Sweden, and United Kingdom, enrolled in the Dialysis Outcomes and Practice Patterns Study phases 4 (2009-2011) and 5 (2012-2015). MIC syndrome was defined as low serum albumin (&amp;lt;3.8 g/dL) and high serum C-reactive protein (&amp;gt;3mg/L in Japan; &amp;gt;10 mg/L elsewhere). Poor functional status was defined as the sum of scores from the self-reported limitations in the Katz Index of Independence in Activities of Daily Living (score ranges from 0 to 5) and the Lawton-Brody Instrumental Activities of Daily Living Scale (score ranges from 0 to 8) less than 11. We investigated the association between combinations of MIC (+/-) and FS (low/high) with death, using Cox proportional hazards models adjusted for possible confounders including patient demographics, comorbidity history, catheter use, serum creatinine, phosphorus levels, WBC count, haemoglobin level, and time on dialysis therapy. Results The prevalence of different combinations were: MIC-/High FS 57%, MIC-/Low FS 24%, MIC+/High FS 9%, and MIC+/Low FS 10%. Patients with MIC-/high FS were younger, better nourished, and had lower prevalence of comorbidities. Compared to this reference group, the adjusted hazard ratios [HR (95% CI)] for all-cause mortality were 1.56 (1.24-1.98) for MIC-/ low FS, 1.75 (1.32-2.32) for MIC+/ high FS, and 2.97 (2.31-3.82) for MIC+/ low FS groups. The adjusted HRs for infection-related mortality were 1.57 (0.91, 2.71) for MIC-/low FS, 1.67 (0.84, 3.31) for MIC+/High FS, and 5.45 (3.15, 9.45) for MIC+/low FS groups. Conclusion The combination of MIC and low FS is a strong predictor of mortality, and infectious mortality in particular, in HD patients. Identification of patients with MIC and FS status may plausibly help to direct interventions to improve patients’ experiences and lessen adverse clinical outcomes in the HD setting.

Impact of Periodontal Inflammation on Nutrition and Inflammation Markers in Hemodialysis Patients.

Background: Malnutrition-inflammation complex syndrome (MICS) is a common and usually concurrent condition occurring in patients undergoing hemodialysis (HD), with a pathogenesis linked to biological and in situ environmental traditional risk factors. Periodontitis, one of the major types of infection-driven inflammation, often co-occurs in the in the hemodialysis population and correlates with markers of malnutrition and inflammation, such as albumin, creatinine, and C-reactive protein. Aim: The present study aimed to determine whether the periodontal inflammatory status parameters correlate with the albumin, creatinine, and C-reactive protein serum concentrations in HD patients, and investigate whether periodontal treatment improves these markers of nutritional and systemic inflammation. Materials and Methods: The serum creatinine, albumin, and C-reactive Protein (CRP) levels were measured at baseline and after non-surgical periodontal treatment, at 3 months and 6 months. Results: At 3 months, a significant correlation between plaque index and C-reactive protein (p = 0.012), bleeding on probing and C-reactive protein (p < 0.0019), and clinical attachment level and C-reactive protein (p = 0.022) was found. No significant correlation was found between clinical periodontal parameters and nutrition markers at each time. Conclusions: Our results confirmed the association between C-reactive protein serum concentration and periodontal inflammatory status, but further research is necessary to identify the contributing role of periodontitis on the onset and progression of MICS.

Inflammation and nutritional status assessment by malnutrition inflammation score and its outcome in pre-dialysis chronic kidney disease patients

Malnutrition-inflammation complex syndrome (MICS), hyperhomocysteinemia, calcium and phosphate levels derangement have been predicted as important contributing factors for the progression of cardiovascular burden. Among patients with earlier stage of CKD, hypoalbuminaemia and inflammation deliberated as non-traditional cardiovascular risk factors, which add more burden to circulatory disease, mortality and rapid advancement to CKD stage 5. The aim of the study is to evaluate inflammation and nutritional status of CKD patients not on dialysis using Malnutrition inflammation score (MIS) and to verify the association with mortality in the follow-up period. In this prospective cohort study 129 (66 males, 63 females) pre-dialysis CKD patients enrolled between June 2013 to August 2014 and censored until March 2017. Malnutrition and Inflammation assessed using Malnutrition inflammation score. Blood urea nitrogen, serum creatinine, albumin, Interleukin - 6, highly sensitive C reactive protein (hsCRP), total cholesterol and anthropometric data were analyzed. The Malnutrition inflammation score in pre-dialysis CKD patients ranged from 0 to 18 with the median score of two. During 36 or more months of follow-up, there were 30 (23.2%) deaths, 35 (27%) patients initiated on hemodialysis, one (0.7%) patient was initiated on peritoneal dialysis, two (1.4%) patients underwent renal transplantation and two (1.4%) patients were lost for follow-up. In this study, 33% had varying degree of malnutrition and inflammation. Patients who had MIS ≥7 had significant increase in IL-6 (p=0.003) and HsCRP levels (p<0.001) when compared with other tertiles of MIS. ROC curve analysis of MIS showed 56.5% sensitivity and 81% specificity in predicting death rate (AUC 0.709; 95% CI 0.604-0.815, p<0.001). Kaplan-Meier survival analysis showed MIS ≥7 had a strong association (log rank test, p<0.001) with mortality during 36 and more months of follow-up time. In unadjusted analyses, MIS (HR 1.140; 95% CI 1.054-1.233; p<0.05) and HsCRP (HR 2.369; 95% CI 1.779-3.154; p<0.001) found to be predictors of mortality. MIS and HsCRP remained predictors of mortality even after adjustments. This study shows MIS is an important factor that determines mortality in pre-dialysis CKD patients during 36 and more months of follow-up time. Patients with MIS ≥7 have high risk for mortality and needs close monitoring. In clinical setting application of MIS has a greater utilization in pre-dialysis CKD patients. Further research with longitudinal assessment of MIS and its association with outcomes are warranted. Pre-dialysis CKD patients should be assessed for their nutritional status and inflammation using MIS regularly to prevent malnutrition and its associated complications through appropriate medical and nutritional intervention.

Prevalence of malnutrition-inflammation complex syndrome and its correlation with thyroid hormones in chronic haemodialysis patients

IntroductionLow levels of thyroid hormones, total triiodothyronine (T3) and free triiodothyronine (FT3) in haemodialysis patients are a marker of malnutrition and inflammation and are predictors of mortality. The aim of this study was to determine the prevalence of malnutrition-inflammation complex syndrome in haemodialysis and its relationship with the thyroid hormones thyrotropin, T3, FT3 and free thyroxine (FT4), as well as to evaluate the prevalence of low FT3 syndrome and its correlation with nutritional and inflammatory markers. Materials and methodsCross-sectional, analytical and comparative study that enrolled 128 haemodialysis patients: 50.8% females; mean age 45.05±17.01 years; mean time on haemodialysis 45.4±38.8 months; 29.7% diabetics; 79.7% with hypertension. Serum thyroidhormones thyrotropin, T3, FT3 and FT4 concentrations were measured and Malnutrition-Inflammation Score (MIS) was applied to diagnostic. ResultsMean thyroid hormone values were: thyroid hormones thyrotropin 2.48±1.8mIU/ml (range: 0.015–9.5), T3 1.18±0.39ng/ml (range 0.67–2.64), FT3 5.21±0.96pmol/l (range: 3.47–9.75); FT4 1.35±0.4ng/ml (range: 0.52–2.57). Malnutrition-inflammation complex syndrome prevalence was 53.9%; 11.7% presented low FT3 levels. Serum T3 and FT3 concentrations inversely correlated with Malnutrition-Inflammation Score (MIS), while FT4 correlated positively with Malnutrition-Inflammation Score. In the linear regression analysis, low FT3 was associated with IL-6 (β=0.265, p=.031), C-reactive protein (CRP) (β=−0.313, p=.018) and albumin (β=0.276, p=.002). ConclusionLow T3 and FT3 levels are correlated with malnutrition and inflammation parameters. Malnutrition-inflammation complex syndrome can affect serum concentrations of thyroid hormones.

Prevalencia del síndrome complejo de malnutrición e inflamación y su correlación con las hormonas tiroideas en pacientes en hemodiálisis crónica

IntroductionLow levels of thyroid hormones, total triiodothyronine (T3) and free triiodothyronine (FT3) in haemodialysis patients is a marker of malnutrition and inflammation and are predictors of mortality. The aim of this study was to determine the prevalence of malnutrition-inflammation complex syndrome in haemodialysis and its relationship with the thyroid hormones thyrotropin, T3, FT3 and free thyroxine (FT4), as well as to evaluate the prevalence of low FT3 syndrome and its correlation with nutritional and inflammatory markers. Materials and methodsCross-sectional, analytical and comparative study that enrolled 128 haemodialysis patients: 50.8% females; mean age 45.05±17.01 years; mean time on haemodialysis 45.4±38.8 months; 29.7% diabetics; 79.7% with hypertension. Serum thyroid hormones thyrotropin, T3, FT3 and FT4 concentrations were measured and Malnutritition-Inflammation Score (MIS) was applie to diagnostic. ResultsMean thyroid hormone values were: thyroid hormones thyrotropin 2.48±1.8 mIU/ml (range: 0.015-9.5), T3 1.18±0.39 ng/ml (range 0.67-2.64), FT3 5.21±0.96pmol/l (range: 3.47-9.75); FT4 1.35±0.4 ng/ml (range: 0.52-2.57). Malnutrition-inflammation complex syndrome prevalence was 53.9%; 11.7% presented low FT3 levels. Serum T3 and FT3 concentrations inversely correlated with Malnutritition-Inflammation Score (MIS), while FT4 correlated positively with Malnutrition-Inflammation Score. In the linear regression analysis, low FT3 was associated with IL-6 (β= 0.265, p=.031), C-reactive protein (CRP) (β= -0.313, p=.018) and albumin (β= 0.276, p=.002). ConclusionLow T3 and FT3 levels are correlated with malnutrition and inflammation parameters. Malnutrition-inflammation complex syndrome can affect serum concentrations of thyroid hormones.

Relationship between Malnutrition-Inflammation Complex Syndrome and Fluid Balance in Maintenance Hemodialysis Patients

Relationship between Malnutrition-Inflammation Complex Syndrome and Fluid Balance in Maintenance Hemodialysis Patients

MICS, an easily ignored contributor to arterial calcification in CKD patients.

In chronic kidney disease (CKD), simultaneous mineral and skeleton changes are prevalent, known as CKD-mineral bone disorder (CKD-MBD). Arterial calcification (AC) is a clinically important complication of CKD-MBD. It can increase arterial stiffness, which leads to severe cardiovascular events. However, current treatments have little effect on regression of AC, as its mechanisms are still unclear. There are multiple risk factors of AC, among which Malnutrition-Inflammation Complex Syndrome (MICS) is a new and crucial one. MICS, a combined syndrome of malnutrition and inflammation, generally begins at the early stage of CKD and becomes obvious in end-stage renal disease (ESRD). It was linked to reverse epidemiology and associated with increased cardiovascular mortality in ESRD patients. Recent data suggest that MICS can trigger CKD-MBD and accelerate the course of AC. In this present review, we summarize the recent understanding about the aggravating effects of MICS on AC and discuss the possible underlying mechanisms. A series of findings indicate that targeting MICS will provide a potential strategy for treating AC in CKD.