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. 2021 Jan 15;11(1):1582.
doi: 10.1038/s41598-020-80716-0.

The combination of malnutrition-inflammation and functional status limitations is associated with mortality in hemodialysis patients

Eiichiro Kanda  1 , Marcelo Barreto Lopes  2 , Kazuhiko Tsuruya  3 , Hideki Hirakata  4 , Kunitoshi Iseki  5 , Angelo Karaboyas  2 , Brian Bieber  2 , Stefan H Jacobson  6 , Indranil Dasgupta  7   8 , Bruce M Robinson  2
Affiliations

The combination of malnutrition-inflammation and functional status limitations is associated with mortality in hemodialysis patients

Eiichiro Kanda et al. Sci Rep. .

Abstract

The identification of malnutrition-inflammation-complex (MIC) and functional status (FS) is key to improving patient experience on hemodialysis (HD). We investigate the association of MIC and FS combinations with mortality in HD patients. We analyzed data from 5630 HD patients from 9 countries in DOPPS phases 4-5 (2009-2015) with a median follow-up of 23 [IQR 11, 31] months. MIC was defined as serum albumin < 3.8 g/dL and serum C-reactive protein > 3 mg/L in Japan and > 10 mg/L elsewhere. FS score was defined as the sum of scores from the Katz Index of Independence in Activities of Daily Living and the Lawton-Brody Instrumental Activities of Daily Living Scale. We investigated the association between combinations of MIC (+/-) and FS (low [< 11]/high [≥ 11]) with death. Compared to the reference group (MIC-/high FS), the adjusted hazard ratios [HR (95% CI)] for all-cause mortality were 1.82 (1.49, 2.21) for MIC-/low FS, 1.57 (1.30, 1.89) for MIC+/high FS, and 3.44 (2.80, 4.23) for MIC+/low FS groups. Similar associations were observed with CVD-related and infection-related mortality. The combination of MIC and low FS is a strong predictor of mortality in HD patients. Identification of MIC and poor FS may direct interventions to lessen adverse clinical outcomes in the HD setting.

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Conflict of interest statement

Kazuhiko Tsuruya has received honoraria from Chugai, Kyowa Kirin, Astellas, Mitsubishi Tanabe, Bayer, Kissei, Sumitomo Dainippon, Torii, and Baxter; has received consulting fee from Chugai and Astellas; has received grants from Baxter, Torii, Chugai, and Kyowa Kirin. Eiichiro Kanda, Kunitoshi Iseki, Hideki Hirakata, Stefan H Jacobson, and Indranil Dasgupta have no conflicts of interest to declare.Marcelo Barreto Lopes, Angelo Karaboyas, Brian Bieber, and Bruce M. Robinson are employees of Arbor Research Collaborative for Health, which administers the DOPPS.

Figures

Figure 1
Figure 1
STROBE diagram of the study sample. ADL, activities of daily living; CRP, C-reactive protein.
Figure 2
Figure 2
Distribution of MIC and FS combinations by country. MIC, malnutrition-inflammation-complex; FS, functional status; A/NZ, Australia/ New Zealand; Bel, Belgium; Fra, France; Ita, Italy; Jpn, Japan; Spa, Spain; Swe, Sweden; UK, United Kingdom.
See this image and copyright information in PMC

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