Browse > Article

Comparison of Nutritional Status and Inflammational Markers in DM and nonDM Hemodialysis Patients  

Kim, Su-An (Department of Nutrition Care Services, Seoul National University of Bundang Hospital)
Sohn, Cheong-Min (Department of Nutrition Care Services, Seoul National University of Bundang Hospital)
Chae, Dong-Wan (Department of Internal Medicine, Seoul National University of Bundang Hospital)
Publication Information
Korean Journal of Community Nutrition / v.10, no.5, 2005 , pp. 693-699 More about this Journal
Abstract
Protein-calorie malnutrition is common in maintenance dialysis patients. Indeed, diabetic patients with chronic renal failure are considered to be at increased risk of malnutrition. The aim of this study was to compare the nutritional status and markers of inflammation of hemodialysis patients with and without type 2 diabetes. We compared nutritional parameters and C-reactive protein (CRP) as a marker of inflammation in 30 type 2 diabetic patients and age-matched 30 non-diabetic patients with hemodialysis. Serum albumin was significantly lower in patients with type 2 diabetes $(3.45\pm0.43g/dL)$ than in non-diabetic patients $(3.64\pm0.36 g/dL)$ (p<0.05). In contrast, the concentration of serum CRP was significantly higher in type 2 diabetes $(1.42\pm1.8mg/dL)$ (p<0.05). There were significant negative-relationships between serum albumin and CRP level in both diabetic (r=-0.553, p<0.01) and non-diabetic (r=-0.579, p<0.01) patients. In diabetic patients, serum albumin level was significantly correlated with hemoglobin (r = 0.488, p < 0.01) and hematocrit (r=0.386, p < 0.01). Diabetic patients as compared to non-diabetic patients showed a significant (p < 0.01) increased serum triglyceride (TG) $(153.1\pm80.1mg/dL\;vs\;101.6\pm62.4mg/dL)$ and decreased serum HDL cholesterol $(36.89\pm13.48mg/dL\;vs\;47.00\pm14.02mg/dL,\;P<0.05)$. There were significant correlations in the intake of calorie and serum albumin levels in both diabetic (r=0.438, p< 0.05) and non-diabetic (r=0.527, p<0.05) patients. Serum CRP level was negatively correlated with calorie (r= -0.468, p < 0.05), protein (r=-0.520, p < 0.01) and fat intakes (r=-0.403, p < 0.05) in diabetic patients and calorie (r=-0.534, p<0.05) and protein intakes (r=-0.559, p<0.05) in non-diabetic patients. The prevalence of protein malnutrition and the risk factors of cardiovascular disease were significantly higher in type 2 diabetic patients than in non-diabetic hemodialysis patients. Thus, we can suggest that the higher comorbidity and mortality rate in diabetic hemodialysis patients are partially explained by malnutrition and inflammation.
Keywords
hemodialysis; nutritional status; inflammation; diabetes mellitus;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Biesenbach G, Debska-Slizien A, Zazgornik J (1999): Nutritional status in type 2 diabetic patients requiring haemodialysis. Nephrol Dial Transplant 14(3): 655-658   DOI   ScienceOn
2 Daugirdas JT (1993): Second generation logarithmic estimates of singlepool variable volume Kt/V: an analysis of error. J Am Soc Nephrol 4(5): 1205-1213
3 Ikizler TA, Rebecca L. Wingard, Janice Harvell, Yu Shyr, Raymond M. Hakim (1999): Association of morbidity with markers of nutrition and inflammation in chronic hemodialysis patients: A prospective study. Kidney International 55(5): 1945-1951   DOI   ScienceOn
4 Kalantar-Zadeh K, Ikizler TA, Block G, Avram MM, Kopple JD (2003): Malnutrition-inflammation complex syndrome in dialysis patients: causes and consequences. Am J Kidney Dis 42(5): 864-881   DOI   ScienceOn
5 Kim Myung Sik, Ko Kyung Soo, Park Won Do (1996): Assessment of Parameters between Diabetic and Non-diabetic Patients Undergoing Maintenance Hemodialysis. The Korean Journal of Internal Medicine 51(4): 472-479
6 Locatelli F, Fouque D, Heimburger O, Drueke TB, Cannata-Andia JB, Horl WH, Ritz E (2002): Nutritional status in dialysis patients: a European consensus. Nephrol Dial Transplant 17(4): 563-572   DOI   ScienceOn
7 Nakao T, Matsumoto H, Okada T, Kanazawa Y, Yoshino M, Nagaoka Y, Takeguchi F (2003): Nutritional management of dialysis patients: balancing among nutrient intake, dialysis dose, and nutritional status. Am J Kidney Dis 41(3 Suppl 1): S133-136   DOI   ScienceOn
8 Park CW, Shin YS, Kim CM, Lee SY, Yu SE, Kim SY, Choi EJ, Chang YS, Bang BK (2002): Increased C-reactive protein following hemodialysis predicts cardiac hypertrophy in chronic hemodialysis patients. Am J Kidney Dis 40(6): 1230-1239   DOI   ScienceOn
9 Torzewski J, Torzewski M, Bowyer DE, Frohlich M, Koenig W, Waltenberger J, Fitzsimmons C, Hombach V (1998): C-reactive protein frequently colocalizes with the terminal complement complex in the intima of early atherosclerotic lesions of human coronary arteries. Arterioscler Thromb Vasc Biol 18(9): 1386-1392   DOI   ScienceOn
10 Khovidhunkit W, Memon RA, Feingold KR, Grunfeld C (2000): Infection and inflammation-induced proatherogenic changes of lipoproteins. J Infect Dis 181(Suppl 3): S462-S472   DOI   ScienceOn
11 National Kidney Foundation (2000): K/DOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure. Am J Kidney Dis 35 (suppl 2): S1-S104   DOI   ScienceOn
12 Foley RN, Parfrey PS, Sarnak MJ (1998): Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 32(5 Suppl 3): S112-S119   DOI   ScienceOn
13 Burrowes JD, Cockram DB, Dwyer JT, Larive B, Paranandi L, Bergen C, Poole D (2002): Cross- sectional relationship between dietary protein and energy intake, nutritional status, functional status, and comorbidity in older versus younger hemodialysis patients. Ren Nutr 12(2): 87-95   DOI   ScienceOn
14 Coffman TM, Cheung AK, Falk RJ, Jennette JC, Greenberg A (2001): Primer on Kidney Diseases. Academic press, pp.420-425
15 Qureshi AR, Alvestrand A, Danielsson A, Divino-Filho JC, Gutierrez A, Lindholm B, Bergstrom J (1998): Factors predicting malnutrition in hemodialysis patients: a cross-sectional study. Kidney Int 53(3): 773-782   DOI   ScienceOn
16 Locatelli F, Pisoni RL, Akizawa T, Cruz JM, DeOreo PB, Lameire NH, Held PJ (2004): Anemia management for hemodialysis patients: Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines and Dialysis Outcomes and Practice Patterns Study (DOPPS) findings. Am J Kidney Dis 44(5 Suppl 3): 27-33   DOI   ScienceOn
17 Kopple JD, Massry SG (2004): Kopple and Massry's nutritional management or renal disease. 2nd edition. Lippincott Williams & Wilkins
18 Park Jeong Sig, Kim Sun Bae (2004): Clinical Significance of C-reactive Protein in Patients with End-stage Renal Disease. The Korean Society of Nephrology 23(2): 185-187
19 Slomowitz LA, Monteon FJ, Grosvenor M, Laidlaw SA, Kopple JD (1989): Effect of energy intake on nutritional status in maintenance hemodialysis patients. Kidney Int 35(2): 704-711   DOI   ScienceOn
20 Docci D, Bilancioni R, Buscaroli A, Baldrati L, Capponcini C, Mengozzi S, Turci F, Feletti C (1990): Elevated serum levels of C-reactive protein in hemodialysis patients. Nephron 56(4): 364-367   DOI   PUBMED
21 Lagrand WK, Niessen HW, Wolbink GJ, Jaspars LH, Visser CA, Verheugt FW, Meijer CJ, Hack CE (1997): C-reactive protein colocalizes with complement in human hearts during acute myocardial infarction. Circulation 95(1): 97-103   DOI   ScienceOn
22 Lee CH, Chang HW, Wang IK, Lin CL, Chen TC, Wang PH, Chang HY, Chen JB, Hsu KT, Chuang FR (2004): Diabetes mellitus, hyperhomocystinemia and atherosclerotic vascular disease in Taiwanese chronic hemodialysis patients: a retrospective study. Ren Fail 26(3): 317-323   DOI   ScienceOn
23 Szczech LA, Reddan DN, Klassen PS, Coladonato J, Chua B, Lowrie EG, Lazarus JM, Owen WF Jr (2003): Interactions between dialysis- related volume exposures, nutritional surrogates and mortality among ESRD patients. Nephrol Dial Transplant 18(8): 1585-1591   DOI   ScienceOn
24 Stenvinkel P, Heimburger O, Paultre F, Diczfalusy U, Wang T, Berglund L, Jogestrand T (1999): Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int 55(5): 1899-1911   DOI   ScienceOn
25 Marckmann P (1988): Nutritional status of patients on hemodialysis and peritoneal dialysis. Clin Nephrol 29(2): 75-78
26 Sethi D, Muller BR, Brown EA, Maini RN, Gower PE (1988): C-reactive protein in haemodialysis patients with dialysis arthropathy. Nephrol Dial Transplant 3(3): 269-271
27 Cano NJ, Roth H, Aparicio M, Azar R, Canaud B, Chauveau P, Combe C, Fouque D, Laville M, Leverve XM (2002): French Study Group for Nutrition in Dialysis (FSG-ND). Malnutrition in hemodialysis diabetic patients: evaluation and prognostic influence. Kidney Int 62(2): 593-601   DOI   ScienceOn
28 Pasceri V, Willerson JT, Yeh ET (2000): Direct proinflammatory effect of C-reactive protein on human endothelial cells. Circulation 102 (18): 2165-2168   DOI   ScienceOn
29 Grodstein GP, Blumenkrantz MJ, Kopple JD (1980): Nutritional and metabolic response to catabolic stress in uremia. Am J Clin Nutr 33(7): 1411-1416
30 Johansen OE, Birkeland KI (2003): Preventing macrovascular disease in patients with type 2 diabetes mellitus. Am J Cardiovasc Drugs 3(4): 283-297   DOI   ScienceOn