Calcification, malnutirition, inflammation and atherogenez in dialysis patients

Cardiovascular mortality and morbidity is highly prevalent among patients with chronickidney disease. Beside proinflammatory status and malnutrition, vascular calcification playsan important role at this accelerated atherosclerosis of these patients. Here we aimed toinvestigate the hs-CRP, IL-6 and homocysteine levels and to evaluate the association betweenmalnutrition, vascular-valvular calcification, fetuin-A, osteopontin and atherosclerosis. In thispresent study we found the IMT of the carotid arteries was significantly higher inhemodialysis patients when compared to those in healthy controls. There is positivecorrelation between CA-IMT, score of the SGA and score of the vascular calcification. Also ithas been shown that there is positive correlat,on between the score of the SGA and hs-CRPand vascular-valvular calcification. There was negative correlation between the serumalbumin concentration and vascular calcification scores. The OPN levels were higher indialysis patients when compared to those in the controls. No significant relation wereobserved between the OPN and the score of the SGA, CA-IMT, the score of the vascularcalcification. Fetuin-A levels were significantly higher in dialysis population especially insevelamer users than the healthy controls. IL-6 and homocysteine levels were significantlyincreased in the patients when compared to those in the controls. There was significantcorrelation between the homocysteine levels and hs-CRP, IL-6, uric acide levels. Inconclusion, there is strong association between malnutrition, vascular-valvular calcification,atherosclerosis and inflammation. The relation between inflammation and malnutrition ismore stronger than the relation with calcification and atherosclerosis. Homocysteine playsrole in the formation of the atherosclerosis through the uric acide and cytokine pathways. Thefetuin- A levels show differences in dialysis patients and how fetuin-A levels and calcificationare interracted each other is conflicting. Larger studies are still needed to clarify the role ofosteopontin in the development of malnutrition-inflammation and atherosclerosis.