Hemodialysis and Peritoneal Dialysis

Abstract

Background: Malnutrition, inflammation, and fluid overload can reinforce each other, forming a detrimental syndrome in patients receiving hemodialysis (HD). However, this syndrome remains insufficiently recognized. This study aims to explore the relationship between the malnutrition-inflammation-fluid overload complex syndrome (MIFCS) and all-cause death.

Methods: A retrospective analysis was conducted. Malnutrition, inflammation, and fluid status were evaluated over a 4-month period, while all-cause mortality data were collected during a 7-year follow-up. Fluid status was evaluated using the extracellular water/total body water ratio (ECW/TBW), determined through bioelectrical impedance analysis (BIA). Nutritional status was assessed via the modified creatinine index (mCI), while inflammation was assessed through high-sensitivity C-reactive protein (hs-CRP). The Cox proportional hazards model was applied to develop a nomogram model.

Results: A total of 218 patients were included. The simultaneous presence of malnutrition, inflammation, and fluid overload (FO) was linked to the highest mortality risk (HR, 8.908; 95%CI, 2.986-26.575). A nomogram score based on MIFCS was developed to estimate survival probability at 3, 5, and 7 years. An increase in the nomogram score was progressively linked to an elevated mortality risk, with a hazard ratio of 1.399 (95%CI: 1.298-1.508, p < 0.001) per 10-point increase.

Conclusions: MIFCS was significantly associated with an elevated mortality risk in HD patients. A comprehensive assessment of malnutrition, inflammation, and FO is essential for accurate prognostic assessment and risk stratification.

Keywords: Extracellular water/total body water ratio; hemodialysis; high-sensitivity C-reactive protein; modified creatinine index; prognosis.

Figure 1.

The nomogram for overall survival.ECW, extracellular waster; TBW, total body water; CI, creatinine index; hsCRP, high-sensitivity C-reactive protein.

Figure 2.

Area under the ROC curves (AUC) for survival prediction.

Figure 3.

Time-dependent AUC.

Figure 4.

Calibration plots of survival probabilities at 3 years (a), 5 years (B), and 7 years (C). OS, overall survival. Nomogram-predicted overall survival is plotted on the x-axis, with actual overall survival on the y-axis. Dashed lines along the diagonal line through the origin point represent the perfect calibration models in which the predicted probabilities are identical to the observed probabilities.