The relationship between malnutrition subgroups and volume parameters in predialysis patients

Background: There are two types of malnutrition in patients with chronic renal failure; Type1 and Type 2. The aim of this study is to investigate the relationship between malnutrition and inflammation and relationship between malnutrition and volume status.Material-Methods: 94 predialysis patients with chronic renal failure were included in the study. Nutritional status of patients was calculated using Subjective Global Assessment. Each case was evaluated in terms of the weight change, dietary intake, gastrointestinal symptoms, the presence and severity of comorbidities, functional capacity, signs of muscle wasting, decreased fat stores or loss off subcutaneous fat. Scores of 1 to 5 was given to each category according to the severity of the symptoms and physical examination findings. Serum inflamation markers (hs-CRP, IL-1ß, IL-6, TNF-?) and nutrition parameters (albümin, prealbumin, transferrin, Fetuin-A, IGF-1, IGFBP-3) were measured in all patients. Serum NT-ProBNP levels and echocardiography were performed to evaluate volume status of the patients.Results: The mean age of the patients was 59.63±13.30, the mean malnutrition score was 17.21±6.01, the mean of hs-CRP levels was 18.5±40.7 median:5.6 mg/L, the mean albumin levels was 3.46±0.48 and the mean creatinine clearance was 23.73±13.47ml/min. A positive correlation between malnutrition scores with inflamation and volume parameters has been found in the bivariate and multivariate analysis. On the other hand, a negative correlation was found between inflammation and nutrition and between volume and nutrition parameters. In the multiple regression analysis, volume parameters have been proved to be the most important factors influencing malnutrition scoresDiscussion and Conclusion: Malnutrition is a strong risk factor for increased cardiovascular mortality and morbidity in patients with chronic renal failure. Inflammation plays a fundamental role in initiation and progression of the malnutrition and cardiovascular disease. Our study has shown that there exist significant relationships between malnutrition and inflammation, volume and inflammation, volume and malnutrition. Based on these results, it can be deduced that volume excess is the main culprit in the pathogenesis of both inflammation and malnutrition. These results prompt us to speculate that the elimination of volume excess would ameliorate both inflammation and malnutrition. This hypothesis needs to be proved with prospective studies.