Department of Pediatric Nephrology, Istanbul University Cerrahpasa Faculty of Medicine, 34098, Fatih, Istanbul, Turkey,
Pediatr Nephrol. 2013 Nov;28(11):2149-56. doi: 10.1007/s00467-013-2527-3. Epub 2013 Jun 14.
Malnutrition is associated with both inflammation and atherosclerotic cardiovascular disease in adults with chronic kidney disease. We studied the prevalence of malnutrition and its possible associations with inflammation and vascular disease in children on chronic dialysis.
Thirty-three patients on maintenance dialysis (18 peritoneal dialysis, 15 hemodialysis) and 19 age- and gender- matched healthy controls were studied. Nutritional status was assessed by anthropometric measurements including body mass index (BMI), upper arm measurements, multifrequency bioimpedance analysis (BIA) and serum levels of albumin, prealbumin, and cholesterol. Inflammation was assessed by serum levels of C-reactive protein (CRP), interleukin (IL)-6, and tumor necrosis factor (TNF)-alpha. The carotid artery intima thickness (cIMT) was measured to assess vascular disease.
Compared with healthy children, patients had lower anthropometric measurements (P < 0.05) and serum albumin level (P < 0.001), and higher CRP and TNF-alpha (P = 0.030 and P = 0.007, respectively), and higher cIMT-SDS (P < 0.001). Malnutrition was present in 8 (24%) and lower BIA-based fat mass was independently associated with higher IL-6 levels (P = 0.035). An increased cIMT was present in 16 (48.5%); however, there was no difference in cIMT-SDS between patients with and without malnutrition. Carotid IMT did not show any association with nutritional indices; but positively correlated with serum IL-6 (P = 0.037), CRP (P = 0.012), and iPTH (P = 0.009), and independently associated with only iPTH (P = 0.018).
Children on dialysis are at an increased risk of malnutrition, inflammation, and vascular disease. Although each of these three conditions exists, there is no interaction among them all. We postulate that the malnutrition-inflammation-atherosclerosis (MIA) complex might not exist in pediatric dialysis patients.
营养不良与慢性肾脏病成人的炎症和动脉粥样硬化性心血管疾病均相关。我们研究了慢性透析患儿营养不良的发生率及其与炎症和血管疾病的可能相关性。
研究了 33 名维持性透析（18 名腹膜透析，15 名血液透析）患儿和 19 名年龄和性别匹配的健康对照者。营养状况通过人体测量学指标评估，包括体重指数（BMI）、上臂测量、多频生物电阻抗分析（BIA）以及血清白蛋白、前白蛋白和胆固醇水平。通过血清 C 反应蛋白（CRP）、白细胞介素（IL）-6 和肿瘤坏死因子（TNF）-α评估炎症。通过颈动脉内膜中层厚度（cIMT）评估血管疾病。
与健康儿童相比，患儿的人体测量学指标（P<0.05）和血清白蛋白水平（P<0.001）较低，CRP 和 TNF-α较高（P=0.030 和 P=0.007），cIMT-SDS 较高（P<0.001）。8 例（24%）存在营养不良，较低的 BIA 基础脂肪量与较高的 IL-6 水平独立相关（P=0.035）。16 例（48.5%）存在增厚的 cIMT；然而，营养不良患儿和无营养不良患儿的 cIMT-SDS 无差异。颈动脉 IMT 与营养指标无任何相关性；但与血清 IL-6（P=0.037）、CRP（P=0.012）和 iPTH（P=0.009）呈正相关，与仅 iPTH 独立相关（P=0.018）。
透析患儿营养不良、炎症和血管疾病的风险增加。尽管这三种情况均存在，但它们之间没有相互作用。我们推测营养不良-炎症-动脉粥样硬化（MIA）综合征可能不存在于儿科透析患者中。
