Individual and Combined Prevalence of Malnutrition, Inflammation and Atherosclerosis with Cardiovascular Calcification in Hemodialysis Patients

Abstract

The triad of Malnutrition, Inflammation, Atherosclerosis (MIA) is associated with a high mortality rate in hemodialysis patients. The concomitant existence of cardiovascular calcification worsens the condition. Hence, it is of interest to study whether patients with calcification present with higher prevalence of MIA. The main objective of the study was to assess individual and combined prevalence of MIA with cardiovascular calcification in hemodialysis patients. This was a cross sectional study. Subjects above 18 years of age, undergoing chronic hemodialysis not less than twice a week were screened. Out of 126 screened subjects, 109 were eligible and 100 completed the study. Blood samples were drawn for renal profile, calcium, phosphorus, vitamin D3, parathyroid hormone (PTH), lipid profile and high sensitivity (hs) CRP. Computed Tomography (CT) scans of coronary arteries and Subjective Global Assessment (SGA) score were performed. A comparison of individual and combined prevalence of MIA was reported using Z-test for proportions. When individual conditions were compared, the prevalence of atherosclerosis was found to be highly significant (P: 42%, N: 10%, p-value: 0.00001). When a combined prevalence of all three conditions was compared, it was found to be highly significant in calcified subjects (P: 17%, N: 0%, p-value: 0.000001). It was concluded that the prevalence of MIA syndrome individually or in a combined form was greater in subjects with cardiovascular calcification. This may further predispose this group to increased risk of morbidity and mortality. Early screening of these conditions and planning of treatment strategies to lower them are recommended.