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Background: Mortality resulting from cardiovascular disease in patients with end-stage renal disease (ESRD) is high. In this study we studied characteristics of the malnutrition, inflammation, atherosclerosis  (MIA) syndrome; clinical value syndrome for prediction of cardiovascular events in patients with ESRD. Subjects and methods: A total of 174 patients without infection (i nclude: 57 predialysis patients, 56 continuous ambulatory peritoneal dialysis patients, 61 hemodialysis patients) were enrolled. Inflammatory markers (hs-CRP) and nutritional parameter (SGA) were determined. Carotid atherosclerosis was investigated by ultrasonographically evaluated carotid intima-media thickness (clMT). CVD events (heart failure, cerebrovascular disease, coronary heart disease, hypertensive crisis) were evaluated during 12 months of follow-up. Results: (1) The characteristics of the malnutrition, inflammation, atherosclerosis (MIA) syndrome in patients with ESR D: (i) MIA2-3 group had an average systolic blood pressure higher than MIAO and MIAl group; (ii) MIA2-3 group had higher hs-CRP, IL-6 levels and lower serum albumin levels; (iii) MIA2-3 group had the prevalence of malnutrition  and  atherosclerosis higher  than  MIAl group; 5.7%  of  the patients  had all three risk factors.  No signs  of either  malnutrition,  inflammation  or  atherosclerosis were seen  in 17.2% of pati ents. (2) Value of MIA syndrome for prediction of cardiovascular events in patients  with ESRD  during 12 months of follow-up: The HR  for  patients  with M (malnutrition)  and A (Atherosclerosis) was  2.47 (95% Cl: 1.52 - 4.03; p = 0.001) and 1.77 (95% Cl: 1.10 - 2.83; p = 0.02). The HR for patients with 2 or more elements in MIA syndrome was 1.54 (95% Cl : 1.06-2.26; p = 0.03). Conclusion: Malnutrition, inflammation and atherosclerosis appear to be interrelated. The concurrent presence of malnutrition, inflammation and atherosclerosis increased the risk of cardiovascular events in patients with ESRD

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