Background/Aims: The prevalence ofcardiovascular disease and mortality rate is relatively low in Chinese dialysis patients. This study aimed to evaluate the predictive value of nutritional and inflammatory markers in Chinese hemodialysis patients. Methods: A total of 158 patients (70 men and 88 women, age 59.9 ± 13.2 years) were studied. Nutritional and inflammatory markers, including subjective global assessment (SGA), insulin-like growth factor-1, albumin, tumor necrosis factor-α, interleukin (IL)-1β, IL-6, serum amyloid A (SAA), and C-reactive protein (CRP), were measured. These patients were followed up until April 2004 (36 months) to determine the incidence and causes of death. Results: SGA (p = 0.001), IL-1β (p = 0.032), SAA (p = 0.031), IL-6 (p = 0.001) and CRP (p < 0.001) were found to be significant predictors of mortality. After adjusting with age, sex, diabetes, coronary artery disease, Kt/Vurea, and duration on dialysis, CRP (odds ratio = 4.58; p = 0.038) and SGA (odds ratio = 6.57; p = 0.004) remained the independent predictors of mortality. The adjusted mortality rate was highest for patients with a high CRP level and malnutrition (assessed by SGA). Conclusions: SGA and CRP levels are the most significant predictors of mortality in Chinese dialysis patients. Chinese dialysis patients with a high CRP level tend to be at higher risk of mortality only if they are malnourished.

Keywords:
Hemodialysis, Inflammation, Nutrition, Chinese HD patients, nutritional/inflammatory markers
1.
Owen WFJ, Lew NL, Liu Y, Lowrie EG, Lazarus JM: The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis. N Engl J Med 1993;329:1001–1006.
2.
Yeun JY, Kaysen GA: Factors influence serum albumin in dialysis patients. Am J Kidney Dis 1998;32(suppl 4):S118–S125.
3.
Kaizu Y, Kimura M, Yoneyama T, Miyaji K, Hibi I, Kumagai H: Interleukin-6 may mediate malnutrition in chronic hemodialysis patients. Am J Kidney Dis 1998;31:93–100.
4.
Stenvinkel P: Inflammation in end-stage renal failure: Could it be treated? Nephrol Dial Transplant 2002;17(suppl 8):33–38.
5.
Kaysen GA, Stevenson FT, Depner TA: Determinants of albumin concentration in hemodialysis patients. Am J Kidney Dis 1997;29:658–668.
6.
Bologa RM, Levine DM, Parker TS, Cheigh JS, Serur D, Stenzel KH, Rubin AL: Interleukin-6 predicts hypoalbuminemia, hypocholesterolemia, and mortality in hemodialysis patients. Am J Kidney Dis 1998;32:107–114.
7.
Gabay C, Kushner I: Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999;340:448–453.
8.
Yeun JY, Levine RA, Mantadilok V, Kaysen GA: C-reactive protein predicts all-cause and cardiovascular mortality in hemodialysis patients. Am J Kidney Dis 2000;35:469–476.
9.
Hwang SJ, Yang WG, and the Dialysis Surveillance Committee, TSN. 1999 national dialysis surveillance in Taiwan. Acta Nephrol 2000;14:139–228.
10.
Nakai S, Shinzato T, Sanaka T, et al: The current state of chronic dialysis treatment in Japan (as of 31 December 2000). J Jpn Soc Dial Ther2002;35:1–28.
11.
US Renal Data System, USRDS 2000 Annual Data Report, June 2000. Bethesda, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2000.
12.
Pei YP, Greenwood CM, Chery AL, Wu GG: Racial differences in survival of patients in dialysis. Kidney Int 2000;58:1293–1299.
13.
Rose R: Atherosclerosis – An inflammatory disease. N Engl J Med 1999;340:115–126.
14.
Volpato S, Guralnik JM, Ferrucci L, et al: Cardiovascular disease, interleukin-6, and risk of mortality in older women. The Woman’s Health and Aging Study. Circulation 2001;103:947–953
15.
Yang CS, Chen SW, Chiang CH, Wang M, Peng SJ, Kan YT: Effects of increasing dialysis dose on serum albumin and mortality in hemodialysis patients. Am J Kidney Dis 1996;27:380–386.
16.
Gotch F: Kinetic modeling in hemodialysis; in Nissenson AR, Fine RN, Gentile DE (eds): Clinical Dialysis, ed 3. Norwalk, Appleton & Lange, 1996, pp 156–189.
17.
CANUSA Peritoneal Dialysis Study Group: Adequacy of dialysis and nutrition in continuous peritoneal dialysis: Association with clinical outcomes. Canada-USA (CANUSA) Peritoneal Dialysis Study Group. J Am Soc Nephrol 1996;7:198–207.
18.
Moldawer L, Andersson C, Gelin J, Lundholm KG: Regulation of food intake and hepatic protein synthesis by recombinant-derived cytokines. Am J Physiol 1988;254:G450–G456.
19.
Kaysen GA, Dubin JA, Muller HG, Mitch WE, Rosales LM, Levin NW: Relationships among inflammation, nutrition and physiologic mechanisms establishing albumin levels in hemodialysis patients. Kidney Int 2002;61:2240–2249.
20.
Struijk DG, Krediet RT, Koomen GCM, Boeschoten EW, Arisz L: The effect of serum albumin at the start of continuous ambulatory peritoneal dialysis treatment on patient survival. Perit Dial Int 1994;14:121–126.
21.
Qureshi AR, Alvestrand A, Danielsson A, et al: Factors predicting malnutrition in hemodialysis patients: A cross-sectional study. Kidney Int 1998;53:773–782.
22.
Clemmons DR, Klibanski A, Underwood LE, et al: Reduction of plasma immunoreactive somatomedin C during fasting in humans. J Clin Endocrinol Metab 1981;53:1247–1250.
23.
Pecoits-Filho R, Bárány P, Lindholm B, Heimbürger O, Stenvinkel P: Interleukin-6 is an independent predictor of mortality in patients starting dialysis treatment. Nephrol Dial Transplant 2002;17:1684–1688.
24.
McCarty MF: Interleukin-6 as a central mediator of cardiovascular risk associated with chronic inflammation, smoking, diabetes, and visceral obesity: Downregulation with essential fatty acids, ethanol and pentoxifylline. Med Hypotheses 1999;52:465–477.
25.
Iseki K, Tozawa M, Yoshi S, Fukiyama K: Serum C-reactive protein and risk of death in chronic dialysis patients. Nephrol Dial Transplant 1999;14:1956–1960.
26.
Weinhold B, Rüther U: Interleukin-6-dependent and -independent regulation of the human C-reactive protein gene. Biochem J 1997;327:425–429.
27.
Stenvinkel P, Heimbürger O, Paultre F, et al: Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int 1999;55:1899–1911.
28.
Boenisch O, Ehmke KD, Heddergott A, Naoum C, Frei U, Schindler R: C-reactive-protein and cytokine plasma levels in hemodialysis patients. J Nephrol 2002;15:547–551.
© 2005 S. Karger AG, Basel
2005
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