Malnutrition, inflammation, and atherosclerosis syndrome components predicts poor cardiovascular outcomes in patients with stage 3-5 chronic kidney disease

Introduction and Aims: Malnutrition, inflammation, atherosclerosis syndrome (MIA) is common in end-stage renal disease patients and related to increased cardiovascular (CV) mortality. Several studies investigated frequency of MIA and related poor outcomes in hemodialysis and peritoneal dialysis patients. However, there is no study in the literature to date examining prevalence of MIA and frequency of individual components of MIA in patients with chronic kidney disease (CKD). Thus, we aimed to determine prevalence of MIA components and their predictive ability of poor outcomes in a cohort of stage 3-5 CKD patients. Methods: This is a retrospective longitudinal observational study. 269 patients included in the final analysis. There were 87 patients with stage 3, 86 patients with stage 4, and 96 patients with stage 5 CKD. None of the patients in stage-5 were undergoing hemodialysis. Cardiovascular outcomes were determined from the day of examination onwards, with a mean follow-up period of 38 (range 2 to 43) months. Three components of MIA syndrome were defined as presence of hypoalbuminemia (<3.5 g/dL), increased inflammation (CRP >10 ng/dL) and intima media thickness of carotid artery (IMT>9 mm). Results: Cardiovascular mortality (n=29) was defined as death due to coronary heart disease (18), sudden death (3), stroke (5) or complicated peripheral vascular disease (3). In addition to the 14 cardiovascular deaths, 74 non-fatal cardiovascular events were registered during the follow-up as follows: stroke (19); myocardial infarction (45); peripheral vascular disease (8) and aortic aneurysm (2). There was only 20 patients (7%) who had none of the MIA components (MIA-0). Other patients had at least one component of MIA (185 patients had 1 (MIA-1), 49 had 2 (MIA-2) and 15 patients had all three components (MIA-3)). Comonent numbers of MIA significantly increased from stage-3 CKD to stage-5. Only 8% of stage-5 patients were MIA-0. Composite CV adverse events significantly increased while number of MIA components increase (20% in MIA-0, 80% in MIA-3, p