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Original scientific paper

Clinical significance of the malnutrition-inflammation-atherosclerosis syndrome in the patients on maintenance hemodialysis

Sanjin Rački ; Zavod za nefrologiju i dijalizu, Klinika za internu medicinu, Klinički bolnički centar Rijeka
Božidar Vujičić ; Zavod za nefrologiju i dijalizu, Klinika za internu medicinu, Klinički bolnički centar Rijeka
Ivan Bubić ; Zavod za nefrologiju i dijalizu, Klinika za internu medicinu, Klinički bolnički centar Rijeka
Ines Mrakovčić-Šutić ; Zavod za fiziologiju i imunologiju, Medicinski fakultet Sveučilišta u Rijeci
Petar Kes ; Zavod za nefrologiju, arterijsku hipertenziju i dijalizu, Klinika za unutarnje bolesti, Klinički bolnički centar Zagreb, Zagreb
Štefica Dvornik ; Klinički zavod za laboratorijsku dijagnostiku, KBC Rijeka
Žarko Mavrić ; Zavod za kardiovaskularne bolesti, Klinika za internu medicinu, KBC Rijeka
Luka Zaputović

Full text: croatian pdf 600 Kb

page 519-532

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Objectives. To evaluate the clinical significance of the Malnutrition-Inflammation-
Atherosclerosis (MIA) syndrome as a cardiovascular risk factor in the maintenance hemodialysis
patients. Patients and Methods. 208 maintenance hemodialysis patients were assessed
at the Nephrology and Dialysis Department of the University Clinical Hospital Rijeka.
A total of 168 patients were analyzed. The diagnosis of MIA syndrome was established using
the MIA score assessed with appropriate scale and it was present in 66 patients. Two-year
mortality and morbidity was followed according to presence of MIA syndrome. Patients
with MIA syndrome were randomized into 4 groups and treated with atorvastatin, online
hemodiafiltation (OL-HDF), Helixone® membrane, and standard hemodialysis. The MIA syndrome
parameters were evaluated after follow-uP of 12 and 24 months. A statistical analysis
was performed using the appropriate tests using the statistical software MedCalc 7.5 (Med-
Calc, Mariakerke, Belgium). Results. Mean patients age was 63±13 years with equal gender
distribution. The most common underlying renal disease was chronic glomerulonephritis (31.0 %). The MIA syndrome was present in 39.3 % of patients.
Their mortality was significantly higher (36.4 % vs.
12.7 %, P = 0.0006). Causes of death did not differ according
to the presence of MIA syndrome. The most common cause
of death was cardiovascular disease (62.2 %). The patients
treated with atorvastatin, OL-HDF and Helixone® membrane
had better survival than patients treated with standard hemodialysis
(P = 0.0032). Independent mortality predictors in
the patients with MIA syndrome were not found. Treatment
with atorvastatin and OL-HDF significantly reduced serum Creactive
protein levels (P = 0.0161; P = 0.0425) and serum
interleukin-6 levels (P = 0.0005; P = 0.021) after 12 and 24
months, respectively. Conclusion. Atorvastatin, OL-HDF and
use of the new Helixone® membrane was beneficial in the
treatment of patients with MIA syndrome.


atherosclerosis, atorvastatin, cardiovascular diseases, cytokines, MIA syndrome, online hemodiafiltation

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