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Malnutrition and inflammation determine prognosis of patients with CRS type 4
Imari Mimura1, Hiroshi Nishi, Takahiro Nishi
1Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital, Tokyo, Japan. imimura-tky@umin.ac.jp
Insights
Malnutrition and inflammation predict poor survival in new hemodialysis (HD) patients with ischemic heart disease. Lower serum albumin and higher C-reactive protein levels are associated with increased mortality risk.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Uremic patients frequently develop ischemic heart disease before initiating hemodialysis (HD).
- Chronic cardiorenal syndrome is recognized in predialysis patients, but prognostic factors in incident HD patients are poorly understood.
Purpose of the Study:
- To identify prognostic factors for mortality in incident hemodialysis patients with cardiorenal syndrome type 4 (chronic cardiorenal syndrome).
Main Methods:
- Retrospective analysis of 87 incident HD patients diagnosed with cardiorenal syndrome type 4 between 1984 and 2003.
- Examination of survival and risk factors for mortality.
Main Results:
- The 5-year survival rate was approximately 75%, with 25 deaths observed.
- Lower serum albumin levels (p=0.03) and higher serum C-reactive protein levels (p=0.02) were significantly associated with increased all-cause and adjusted mortality.
Conclusions:
- Malnutrition (indicated by low albumin) and inflammation (indicated by high C-reactive protein) are significant predictors of poor survival in incident HD patients with a history of ischemic heart disease.
Background/Aims:
A significant number of uremic patients develop ischemic heart disease before hemodialysis (HD) is initiated. Recently, chronic cardiorenal syndrome among predialysis patients has been recognized. However, little is known about prognostic factors in this subgroup of incident HD patients.
Methods:
A total of 87 incident HD patients, who were classified into cardiorenal syndrome type 4 (chronic cardiorenal syndrome), were identified at Mitsui Memorial Hospital between 1984 and 2003. The survival and risk factors for mortality were examined.
Results:
25 patients died and the 5-year survival rate amounted to approximately 75%. Both all-cause mortality and the adjusted mortality for age and sex were higher in patients with a lower serum albumin level (p = 0.03) or higher serum C-reactive protein level (p = 0.02).
Conclusion:
The poor survival rate of incident HD patients with a medical history of ischemic heart disease was predicted by malnutrition and inflammation at the start of HD.
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