Individual and Combined Prevalence of Malnutrition, Inflammation and Atherosclerosis with Cardiovascular Calcification in Hemodialysis Patients

Jump To References Section


  • Department of Nephrology, Apex Kidney Care, Mumbai, Maharashtra - 400 064 ,IN
  • Department of Nephrology, Apex Kidney Care, Mumbai, Maharashtra - 400 064 ,IN
  • Department of Nephrology, Apex Kidney Care, Mumbai, Maharashtra - 400 064 ,IN



Malnutrition, Inflammation, Atherosclerosis, Calcification, Hemodialysis.
MIAC syndrome


The triad of Malnutrition, Inflammation, Atherosclerosis (MIA) is associated with a high mortality rate in hemodialysis patients. The concomitant existence of cardiovascular calcification worsens the condition. Hence, it is of interest to study whether patients with calcification present with higher prevalence of MIA. The main objective of the study was to assess individual and combined prevalence of MIA with cardiovascular calcification in hemodialysis patients. This was a cross sectional study. Subjects above 18 years of age, undergoing chronic hemodialysis not less than twice a week were screened. Out of 126 screened subjects, 109 were eligible and 100 completed the study. Blood samples were drawn for renal profile, calcium, phosphorus, vitamin D3, parathyroid hormone (PTH), lipid profile and high sensitivity (hs) CRP. Computed Tomography (CT) scans of coronary arteries and Subjective Global Assessment (SGA) score were performed. A comparison of individual and combined prevalence of MIA was reported using Z-test for proportions. When individual conditions were compared, the prevalence of atherosclerosis was found to be highly significant (P: 42%, N: 10%, p-value: 0.00001). When a combined prevalence of all three conditions was compared, it was found to be highly significant in calcified subjects (P: 17%, N: 0%, p-value: 0.000001). It was concluded that the prevalence of MIA syndrome individually or in a combined form was greater in subjects with cardiovascular calcification. This may further predispose this group to increased risk of morbidity and mortality. Early screening of these conditions and planning of treatment strategies to lower them are recommended.


Download data is not yet available.


Metrics Loading ...



How to Cite

Jasani, R., Kumar, R., & Dedhia, P. (2020). Individual and Combined Prevalence of Malnutrition, Inflammation and Atherosclerosis with Cardiovascular Calcification in Hemodialysis Patients. The Indian Journal of Nutrition and Dietetics, 57(2), 178–184.



Original Articles
Received 2019-11-02
Accepted 2020-02-25
Published 2020-06-23



Caglar, K., Hakim, R. and Ikizler, T. Approaches to the reversal of malnutrition, inflammation and atherosclerosis in End Stage Renal Disease. Nutri. Rev., 2002, 60, 378-387. DOI:

Zapolski, T. Malnutrition-inflammation complex syndrome: link between end-stage renal disease, atherosclerosis and valvular calcification. Hypertension Res., 2010, 33, 541-543. DOI:

Goodman, W.G, Goldin, J., Kuizon, B.D., Yoon, C., Gales, B., Sider, D., Wang, Y., Chung, J., Emerick, A., Greaser, L., Elashoff, R.M. and Salusky, I.B. Coronary artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N. Engl. J. Med., 2000, 342, 1478-1483. DOI:

Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guidelines for the diagnosis, evaluation, prevention and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int. Suppl., 2009, 113, 51-130.

Stenvinkel, P., Heimburger, O., Paultre, F., Diczfalusy, U., Wang, T., Berglund, L. and Jogestrand, T. Strong association between malnutrition, inflammation and atherosclerosis in chronic renal failure. Kidney Intl., 1999, 55, 1899-1911. DOI:

Kalandar, Z., Ikizler, A., Block, G., Avaram, M. and Kopple, J. Malnutrition-inflammation complex syndrome in dialysis patients: cause and consequences. Am. J. Kidney Dis., 2003, 42, 864-881. DOI:

Collins, A.J. Cardiovascular mortality in end-stage renal disease. Am. J. Med. Sci., 2003, 325, 163-167. DOI:

Turkmen, K., Kayikcioglu, H., Ozbek, O., Solak, Y., Kayrak, M., Samur, C., Anil, M. and Zeki Tonbul, H. The relationship between epicardial adipose tissue and malnutrition, inflammation, atherosclerosis/ calcification syndrome in ESRD patients. Clin. J. Am. Soc. Nephrol., 2011, 6, 1920-1925. DOI:

Tintut, Y., Patel, J., Territo, M., Saini, T., Parhami, F. and Demer, L.L. Monocyte/macrophage regulation of vascular calcification in vitro. Circulat., 2002, 105, 650-655. DOI:

Zoccali, C., Mallamaci, F. and Tripepi, G. Traditional and emerging cardiovascular risk factors in end-stage renal disease. Kidney Int. Suppl., 2003, 85, 105-110. DOI:

Tonbul, H.Z., Demir, M., Altintepe, L., Guney, I., Yeter, E., Turk, S., Yeksan, M. and Yildiz, A. Malnutrition-inflammation-atherosclerosis (MIA) syndrome components in hemodialysis and peritoneal dialysis patients. Ren. Fail., 2006, 28, 287-294. DOI:

Stenvinkel, P., Chung, S.H., Heimburger, O. and Lindholm, B. Malnutrition, inflammation and atherosclerosis in peritoneal dialysis patients. Perit. Dial. Int. Suppl., 2001, 21, 157-162. DOI: