Nutritional therapy for patients undergoing hemodialysis.

Protein energy malnutrition (PEM) frequently appears in hemodialysis (HD) patients, and it has been established as a risk factor for morbidity and mortality. Recent studies have shown that inflammation might be a key mediator between PEM and cardiovascular events. On the other hand, it remains unknown whether over-nutrition has an implication as a risk factor for cardiovascular diseases and mortality. Although many studies have indicated that obesity seemed not to be directly associated with mortality, metabolic abnormalities including hypertriglyceridemia, a low level of high-density lipoprotein cholesterol, glucose intolerance and visceral fat accumulation are common in HD patients with over-nutrition. Furthermore, the plasma adiponectin concentration has been reported to show an inverse correlation with the visceral fat mass, and low plasma adiponectin was associated with a high susceptibility to cardiovascular events and mortality in HD patients. These results suggest that nutritional therapy for HD patients may be necessary to consider in patients with either PEM or over-nutrition.