Malnutrition, inflammation, progression of vascular calcification and survival: Inter-relationships in hemodialysis patients

Malnutrition and inflammation are closely linked to vascular calcification (VC), the severity of which correlate with adverse outcome. However, there were few studies on the interplay between malnutrition, inflammation and VC progression, rather than VC presence per se. We aimed to determine the rel...

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Bibliographic Details
Published in:PloS one 2019-05, Vol.14 (5), p.e0216415-e0216415
Main Authors: Choi, Sun Ryoung, Lee, Young-Ki, Cho, A Jin, Park, Hayne Cho, Han, Chae Hoon, Choi, Myung-Jin, Koo, Ja-Ryong, Yoon, Jong-Woo, Noh, Jung Woo
Format: Article
Language:English
Subjects:
Abdomen
Adult
Aged
Aged, 80 and over
Albumin
Aorta
Aorta, Abdominal - diagnostic imaging
Biology and Life Sciences
Blood cholesterol
Body mass index
Calcification
Calcification (ectopic)
Calcification (Physiology)
Cardiovascular diseases
Care and treatment
Cholesterol
Confidence intervals
Coronary vessels
Development and progression
Diabetes mellitus
Dialysis
Disease Progression
Disease-Free Survival
Enrollments
Fatalities
Female
Follow-Up Studies
Health aspects
Health risks
Hemodialysis
Hemodialysis patients
Hospitals
Humans
Inflammation
Inflammation - diagnostic imaging
Inflammation - mortality
Inflammation - therapy
Internal medicine
Kidney diseases
Low density lipoprotein
Low density lipoproteins
Male
Malnutrition
Malnutrition - complications
Malnutrition - diagnostic imaging
Malnutrition - mortality
Malnutrition - therapy
Medical research
Medicine
Medicine and Health Sciences
Metabolism
Middle Aged
Mortality
Nephrology
Obesity
Patient outcomes
Peritoneal dialysis
Physical Sciences
Prospective Studies
Radiography
Regression analysis
Renal Dialysis
Risk analysis
Risk factors
Serum albumin
Statistical analysis
Studies
Survival
Survival Rate
Transplants & implants
Vascular Calcification - diagnostic imaging
Vascular Calcification - etiology
Vascular Calcification - mortality
Vascular Calcification - therapy
Veins & arteries
Venture capital
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Summary:Malnutrition and inflammation are closely linked to vascular calcification (VC), the severity of which correlate with adverse outcome. However, there were few studies on the interplay between malnutrition, inflammation and VC progression, rather than VC presence per se. We aimed to determine the relationship of malnutrition, inflammation, abdominal aortic calcification (AAC) progression with survival in hemodialysis (HD) patients. Malnutrition and inflammation were defined as low serum albumin (< 40 g/L) and high hs-CRP (≥ 28.57 nmol/L), respectively. We defined AAC progression as an increase in AAC score using lateral lumbar radiography at both baseline and one year later. Patients were followed up to investigate the impact of AAC progression on all-cause and cardiovascular mortality. AAC progressed in 54.6% of 97 patients (mean age 58.2±11.7 years, 41.2% men) at 1-year follow-up. Hypoalbuminemia (Odds ratio 3.296; 95% confidence interval 1.178-9.222), hs-CRP (1.561; 1.038-2.348), low LDL-cholesterol (0.976; 0.955-0.996), and the presence of baseline AAC (10.136; 3.173-32.386) were significant risk factors for AAC progression. During the mean follow-up period of 5.9 years, 38(39.2%) patients died and 27(71.0%) of them died of cardiovascular disease. Multivariate Cox regression analysis adjusted for old age, diabetes, cardiovascular history, and hypoalbuminemia determined that AAC progression was an independent predictor of all-cause mortality (2.294; 1.054-4.994). Malnutrition and inflammation were significantly associated with AAC progression. AAC progression is more informative than AAC presence at a given time-point as a predictor of all-cause mortality in patients on maintenance HD.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0216415