Chronic kidney disease-mineral and bone disorder (CKD-MBD) may promote malnutrition-inflammation complex syndrome (MICS) in patients receiving dialysis, according to the authors of a new review.

“CKD-MBD and MICS are highly prevalent complications in the CKD/dialysis population, have a close interaction with one another, and synergistically contribute to heightened risk of morbidity and mortality,” Shunsuke Yamada, MD, PhD, of Kyushu University in Fukuoka, Japan, and colleagues explained in Clinical and Experimental Nephrology.

According to the reviewers, high levels of inorganic phosphate, fibroblast growth factor 23, parathyroid hormone, and calciprotein particles trigger inflammatory responses. This inflammation, in turn, contributes to malnutrition and protein energy wasting (PEW), cardiovascular diseases, and other complications. Preliminary research findings suggest that uncontrolled secondary hyperparathyroidism makes a “substantial contribution” to PEW, frailty, and cachexia in patients.

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To evaluate MICS, the reviewers offered a simplified scoring system comprising 5 components, including age, serum albumin, serum creatinine, C-reactive protein, and body mass index.

Currently, phosphate binders, vitamin D receptor activators, calcimimetics, and some osteoporosis drugs are used to treat CKD-MBD. Exercise with appropriate nutritional therapy may also disrupt aberrations in the blood vessel/Heart–Bone–Skeletal muscle axis.

“Further research is necessary to determine whether simultaneous control of these two seemingly distinct pathologies [CKD-MBD and MICS] can lessen the risk of morbidity and mortality, improve the quality of life and activity of daily living, and secure longevity in the CKD/dialysis population,” Dr Yamada’s team concluded.


Yamada S, Tsuruya K, Kitazono T, Nakano T, et al. Emerging cross-talks between chronic kidney disease-mineral and bone disorder (CKD-MBD) and malnutrition-inflammation complex syndrome (MICS) in patients receiving dialysis. Clin Exp Nephrol. Published online March 30, 2022. doi:10.1007/s10157-022-02216-x