Frequency and Relation of Malnutrition and Inflammation to Atherosclerosis Syndrome in Hemodialysis Patients in Zagazig University Hospitals

Background cardiovascular disease (CVD) still remains the main cause of morbidity and Mortality in maintenance hemodialysis (HD) patients, despite the considerable improvements in dialysis technology. Protein-energy malnutrition and inflammation are common in hemodialysis (HD) patients and these conditions' markers as hypoalbuminemia and elevated hs-C-reactive protein (CRP) have been described as predictive factors of cardiovascular mortality. Inflammatory mediators can induce anorexia, muscle proteolysis, low albumin synthesis, and also contribute to atherogenesis. Objective to assess the frequency and relationship between malnutrition and inflammation to atherosclerosis in CRF patients under hemodialysis. Patients and Method The study was performed on 100 non smoker subjects divided into two groups (1) Patient Group consisted of 50 ESRD patients (24 males, 26 females, mean age 46.1 ? 14.08 years) treated with regular HD for greater than 6 months, in the dialysis unit, Zagazig University. They were recruited for the study from January to June 2013. (2) Control Group consisted of 50 healthy subjects (24 males, 26 females, mean age 41.66 ? 13.73 years). . To all subjects the following was done I- Clinical examination includes detailed history taking with special stress on duration of HD, ischemic heart disease, cerebrovascular or peripheral vascular insufficiency. II-Laboratory Investigations as complete blood count, FBS, P+PBS, hs CRP, liver and kidney function. III- Modified Subjective Global Assessment - Dialysis Malnutrition Score Assessment of the nutritional status using Modified Subjective Global Assessment - Dialysis Malnutrition Score which consists of seven Features. IV- B-Mode Ultrasonography of the Common Carotid Arteries Results. This study shows higher frequency of malnutrition (46%), inflammation (52%), and carotid plaques (48%) in HD patients. The serum creatinine, subjective global assessment ? dialysis modified score (SGA-DMS), hs-CRP and carotid IMT (0.78 ? 0.21 mm) were significantly higher in patients compared with controls while the serum albumin was significantly low in patients compared with controls. Age was positively correlated with IMT and creatinine. Serum creatinine was positive correlation with IMT, hs-CRP and subjective global assessment ? dialysis modified score SGA-DMS while serum albumen negatively correlation with all parameters. Hs-CRP and SGA-DMS was positively correlation with IMT. Conclusions. CRF on HD have higher frequency of malnutrition, inflammation, and carotid plaques and there is strong association of malnutrition and inflammation with atherosclerosis in this subjects Therefor we recommend good nutrition and management of inflammation to decrease occurrence of atherosclerosis and subsequent reduction of cardiovascular events.