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Malnutrition and its association with inflammation and vascular disease in children on maintenance dialysis

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Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

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Disclosure

All the authors declared no conflict of interest. This study was supported by Istanbul University Department of Scientific Research Projects.

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Authors and Affiliations

  1. Department of Pediatric Nephrology, Istanbul University Cerrahpasa Faculty of Medicine, 34098, Fatih, Istanbul, Turkey

    Nur Canpolat, Salim Caliskan, Lale Sever, Mehmet Tasdemir & Gulseren Pehlivan

  2. Department of Biochemistry, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey

    Ozlem Balcı Ekmekci

  3. Renal Unit, Great Ormond Street Hospital for Children, London, UK

    Rukshana Shroff

Authors
  1. Nur Canpolat
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  2. Salim Caliskan
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  3. Lale Sever
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  4. Mehmet Tasdemir
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  5. Ozlem Balcı Ekmekci
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  6. Gulseren Pehlivan
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  7. Rukshana Shroff
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Corresponding author

Correspondence to Nur Canpolat.

Additional information

This study was presented as an oral presentation at the 45th annual meeting of the European Society for Pediatric Nephrology (ESPN) 2012.

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Canpolat, N., Caliskan, S., Sever, L. et al. Malnutrition and its association with inflammation and vascular disease in children on maintenance dialysis. Pediatr Nephrol 28, 2149–2156 (2013). https://doi.org/10.1007/s00467-013-2527-3

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  • DOI: https://doi.org/10.1007/s00467-013-2527-3

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