Therefore, obesity, hypercholesterolemia, and increased blood levels of creatinine and homocysteine appear to be protective and paradoxically associated with a better outcome. Because MICS leads to a low body mass index, hypocholesterolemia, hypocreatininemia, and hypohomocysteinemia, a & amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp quot reverse epidemiology& amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp quot of cardiovascular risks can occur in dialysis patients. MICS is believed to be the main cause of erythropoietin hyporesponsiveness, high rate of cardiovascular atherosclerotic disease, decreased quality of life, and increased mortality and hospitalization in dialysis patients. Possible causes of MICS include comorbid illnesses, oxidative and carbonyl stress, nutrient loss through dialysis, anorexia and low nutrient intake, uremic toxins, decreased clearance of inflammatory cytokines, volume overload, and dialysis-related factors. Hence, malnutrition-inflammation complex syndrome (MICS) is an appropriate term. PEM in dialysis patients has been suggested to be secondary to inflammation however, the evidence is not conclusive, and an equicausal status or even opposite causal direction is possible. Low appetite and a hypercatabolic state are among common features. Both these conditions are related to poor dialysis outcome. Many factors that appear to lead to these 2 conditions overlap, as do assessment tools and such criteria for detecting them as hypoalbuminemia. Protein-energy malnutrition (PEM) and inflammation are common and usually concurrent in maintenance dialysis patients.
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