Nutritional Parameters and Inflammatory Mediators in Maintenance Hemodialysis Patients

Han, S Y; Jo, S K; Yoon, J W; Shin, J H; Lee, S Y; Kang, Y S; Cha, D R; Kwon, Y J; Cho, W Y; Pyo, H J; Kim, H K; Jung, T S

Abstract

Malnutrition is known to be an independent risk factor of morbidity and mortality in hemodialysis patients. The causes of malnutrition were obsucure. Several catabolic cytokines such as interleukin-1beta (IL-1beta), interleukin-6(IL-6), and tumar necrosis factor-alpha (TNF-alpha) were reported to be elevated in hemo-dialysis patients with malnutrition, To evaluate the nutritrional status and relationship among cytokines IL-1beta, TNF-alpha, and various parameters, we performed a cross-sectional study in maintenance hemodialysis patients who have undergone for six months at least. Patients who were taking steroid. showed any sign of infection, or had residual renal function were excluded from the study. Nutritional status was classified into well nourished(A), mild to moderate malnutrition(B), and severe malnutrition(C) by using subjective global assessment(SGA). Patients were divided into two groups (I: A, II: B and C) based on SGA. The level of IL-10, TNF-alpha were estimated by ELISA. Total patients were 23(M/F:15/8 mean age 52.0+/-1.56yrs). There were significant differences in weight changes for 6 months, CRP, and SGA between two groups based on the level of serum albumin (using 4.0g/dL as a cutoff value). Moreover, based on SGA, there were significant differences in age, BMI, CRP, and albumin between the group I and IL Serum albumin levels was directly correlated with transferrin (r=0.302, p=0.04), and was inversly correlated with age (r=-0.329, p=0.007). TNF-alpha was inversly correlated with Kt/Vueea (r=-0.291, p= 0.047), and directly correlated with the duration of maintenance hemodialysis (r=0,346, p=0.036), BMI (r-0.453, p<0.05). These data support the fact that albumin and CRP can be a good marker of nutritional status in maintenance hemodialysis patient. However cytokines and transferrin might not be related to nutritional status.