Potential interplay between nutrition and inflammation in dialysis patients.

Chronic inflammation, which is widely seen in long-term dialysis patients, is associated with malnutrition, atherosclerosis and an increased mortality risk. The relationship between inflammation and nutrition is certainly bidirectional with inflammation affecting nutritional status and dietary factors influencing the state of inflammation. Cytokines, such as IL-6 and TNF-alpha, interfere with the satiety center inducing loss of appetite, delayed gastric emptying and catabolism of skeletal muscle protein. High adipokine levels may also contribute to the development of malnutrition. On the other hand, dietary factors may interfere directly or indirectly with inflammatory activity. For example, dietary AGEs intake may aggravate inflammation while natural antioxidants, such as polyphenolic flavones or vitamin C from fruits and vegetables may even decrease inflammatory activity. Although there is a lack of good prospective nutritional studies in CKD patients, the individual patient should be advised to follow a more Mediterranean-style diet, restrain from broiling meats in order to avoid dietary AGEs, and take multivitamins regularly.