**4. Inflammation and malnutrition**

High concentration of acute phase protein is correlated with low serum albumin in malnourished hemodialysis patients (Kaysen et al., 1997; Qureshi et al., 1998). Low serum albumin concentrations are highly associated with increased mortality risk in patients with renal replacement therapy (Lowrie et al., 1990). Hypoalbuminemia has been traditionally been assumed to result from inadequate protein and calorie intake. However, albumin is a negative acute-phase protein. The synthesis of this protein decreases during inflammation independently of nutritional state. Albumin concentration in dialysis patients is negatively correlated with levels of positive acute-phase protein. Moreover, inflammation and malnutrition data has been associated with the presence of atherosclerotic carotid plaques (Stenvinkel et al., 1999) describing the so called MIA (malnutrition-inflammationatherosclerosis) syndrome in patients with advanced renal failure.

In summary, inflammation is high prevalent among patients with chronic kidney disease and predicts anemia, malnutrition and CV death. An intriguing question is whether CRP is just a sensitive marker of systemic inflammation or actively contributes to the development and progression of atherosclerotic lesions and, therefore, to the CV damage. Some authors have demonstrated CRP content inside the atherosclerotic lesions, suggesting the active participation in the inflammatory process (Zhang et al., 1999) what hints that inflammation could be the cause rather than the consequence of CV damage. Based on the bad prognosis of patients with markers of inflammation, it is important to try to known the possible causes of inflammation in this population in order to prevent morbidity and mortality.
