[Malnutrition -- inflammation -- atherosclerosis (MIA syndrome) in patients with renal failure]

Cardiovascular disease (CVD) is the major cause of death in end-stage renal disease (ESRD). Malnutrition may worsen patient outcome by aggravating existing inflammation and heart failure, accelerating atherosclerosis and increasing susceptibility to infection. Available data demonstrate that chronic inflammation, a non-traditional risk factor which is observed commonly in uremic patients, play a key role in the genesis of both malnutrition and CVD in ESRD. Moreover, inflammation is associated with congestive heart failure. Pro-inflammatory cytokines are pivotal to the inflammation. There is evidence that a chronic inflammation with activation of C-reactive protein, interleukin-6, tumour necrosis factor alpha and other cytokines is associated with increased oxidative stress and endothelial dysfunction in ESRD patients. Strong relations between malnutrition, inflammation and atherosclerosis in ESRD patients suggest the presence of a MIA (malnutrition, inflammation, and atherosclerosis) syndrome, which is associated with high mortality rate. Thus, it could be speculated that suppression of the vicious cycle of malnutrition, inflammation and atherosclerosis (MIA) would improve survival in ESRD patients. Therefore, the early stage of chronic renal failure is the ideal time to start therapeutic interventions.