The Relationship Between Malnutrition, Inflammation And Artherosclerosis In ESRD Patients

Objectives: To know the nutritional status of the renal disease patients with the dialysis therapy, especially their metabolism of protein and amino acids, to provide the scientific basis for clinical nutritional and general therapy.Methods: There were 106 cases with the renal disease randomly selected, 83 cases of which were with hemodi-alysis and 23 cases were with peritoneal dialysis therapy. Their nutritional condition were evaluated by the physical examination and the biochemical assay. The dietary assessment of 26 elderly hemodi-alysis cases was performed by the 24-hour recall and evaluation was carried out by the Quqlity Control System of Clinical Nutrition. And 20 hemodialysis cases were examined serum minerals, protein and amino acids before and after dialysis.Results: The intakes of the total energy of 26 cases of elderly hemodialysis were 8.49±1.82MJ(2031.3±436.1 kcal), and the intakes of protein, fat and carbohydrate were 14.36%, 37.33% and 48.49%, respectively. The source and proportion of protein were reasonable. However the intakes of VD, VB₆, VB₁₂ and calcium were lower than normal, and folic acid, biotin, pantothenic acid iodine were higher. The food pattern and the dietary habit were unreasonable. There were malnutrition very serious, which was found in 56 of 106 cases. The results of the TSF were 50% lower than that of the control group. The Body Mass Index was in according with the body weight. Serum total cholesterol was normal, while triglyceride and apo-a were higher. The haemoglobin and lymphocyte were lower and the retinol-binding protein were higher in the two groups, however, the total protein and albumin were lower in peritoneal dialysis patients, the branch chain amino acid (BCAA) was lower in all patients. The phenylalanine. Praline and glutamic acid were higher. There were no significant difference in the contents of serum calcium, sodium and potassium between dialysis patients and control group, the contents of serum phosphate was higher. The changes of serum retinol-binding-protein, prealbumin and albumin were lesser and transferring was higher in predialysis than that of postdialysis. The serum conecentrations ofpraline, glycine, glutamic acid, cysteine, phenylalanine, lysine, histidine, arginine were decreased and BCAA were increased in postdialysis, and tat of predialysis and postdialysis were both lower than that of the control group.Coneclusions: The results suggest that malnutrition is serious in elderly dialysis patients. The dietary model and form of nutrients are unreasonable. To adapting the principle of the balance diet, the nutritional consulting and eduction should be given. The serum amino acid decreases during the dialysis therapy, and the malnutrition state is more serious in hemodialysis patients. The relationship between malnutrition,inflammation and artherosclerosis in ESRD patientsObjective: To explore the relationship between malnutrition n inflammation and artherosclerosis in end-stage renal disease(ESRD) patients. Methods: 44 ESRD patients, 24 non-dialysis, 19 dialysis were included in this study. HK BUNn SCr> Alb, PA, TRF;TC, TG, HDL-C, LDL-C, Apo-AK ApoB and Lp(a) were measured. Chronic inflammation index such as IL-lp, IL-2> IL-6> IL-8, IL-10> TNF-a , CRP> FDP, C3, C4;Ca, P^ AKP, PTH;Fe, TIBC, ferritin and IRI were also measured. Chromatic colour ultrasound observe anatomy and hemodynamics of carotid artery, the crotch of carotid artery and internal carotid artery,including thickness of blood vessel endothelium (I.e thickness of endomembrane-tunica mediaJMT), plaque, Maximum Velocity(Vmax) and Minimum Velocity(Vmin)( I.e peak value of blood flow rate in systolic phase and diastolic phase),resistent index (RI) and so on .Patients were selected by heart chromatic colour ultrasound also measured IVSd, LVPWd> LVIDd> EF^ E / A and so on. According to the value of CRP,patients were divided as CRP<10mg/L group and CRP>10mg/L group,then each index in CRP>10mg/L group have correlation analysis. Results: The other index of non-dialysis group had no statistical significance as compared with dialysis group,except BUN,Scr,FDP decrease and TG increase obviously. IMT in CRP<10mg/Lgroup was significantly thickeningthan CRP>10mg/L group. The incidence rate of carotid artery plaque in CRP<10mg/L group was 27.2%,while in CRP>10mg/L group the incidence rate was 47.6%. PA ,Scr, HDL, LDL-C were decreased significantly, IL-1, IL-6, IL-8 were increased obviously, but had not any statistically significant. Correlation analysis showed that nutrition parameter such as TP, ALB, TRF, PA> BMI had correlation with CRP, IL-1 , IL-2, IL-6, IL-8, IL-1, TNF-cu FDP, among the tota 1, TRF, PA, BMI had more closer correlation with CRP, IL2, IL6> IL8.Atherosclerosis paramete such as PTH, HDL, LDL-C had comparatively strong correlation with CRP, IL-1, IL-2, IL-6, IL-8, IL-10,TNFa, FDP. PTH, HDL, LDL-C, Lpa also had a comparatively strong correlation with IVSd , LVPWd . The correlation between atherosclerosis paramete (TCH, TG, HDL, LDL-C , Lpa , PTH) and malnutrition paramete (TP, ALB, TRF , PA , BMI) had statistical significance.According to standard canonical correlation coefficient, PTH , HDL , LDL-C had a more closer correlation with TP , ALB, PA. The correlation between nutrition paramete (TP, ALB, TRF, PA, BMI) and ventricular wall thickness paramete(IVSd , LVPWd) had statistical significance, of the total, TP, ALB, TRF, PA, BMI had a more closer correlation with IVSd , LVPWd. IL-2, IL-8, FDP had comparatively strong correlation with IVSd , LVPWd . IL-1, IL-6, IL-8 had a positive correlation with IMT, while BMI had a negative correlation with IMT. Conclusions: 50% of ESRD patients have inflammatory reaction, malnutrition, inflammation and artherosclerosis have close correlation with each other.