It could be that markers of nutrition are really markers of inflammation and that, no matter how much we feed our patients or how many dietary interventions there are, it is not going to have an impact on their traditional nutritional markers. Inflammation is probably playing an unrelenting, not quite so obvious background role. SIR causes anorexia. Whole body protein synthesis is decreased, and the whole body protein breakdown is increased. ESRD and dialysis leads to inflammation and malnutrition and altered body composition of protein.
Patients lose their body mass and the albumin drops.
The protein content of the body is strongly associated with the likelihood of survival. Therefore, malnutrition is also probably an inflammatory disorder as well as an under-eating problem. Now that we are doing a much better job correcting metabolic acidosis and getting our patients to eat, we must concentrate on inflammation. Here's a brief primer on inflammation. There are certain conditions such as congestive heart failure, chronic lung disease, diabetes, acidosis, cancer, trauma, influenza, and dialysis, that activate certain kinds of white blood cells.