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The combination of malnutrition-inflammation and functional status limitations is associated with mortality in hemodialysis patients.
Sci Rep. 2021 01 15; 11(1):1582.SR

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.

Authors+Show Affiliations

Medical Science, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan. kms.cds.kanda@gmail.com.Arbor Research Collaborative for Health, Ann Arbor, MI, USA.Department of Nephrology, Nara Medical University, Nara, Japan.Fukuoka Renal Clinic, Fukuoka, Japan.Nakamura Clinic, Okinawa, Japan.Arbor Research Collaborative for Health, Ann Arbor, MI, USA.Arbor Research Collaborative for Health, Ann Arbor, MI, USA.Division of Nephrology, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.Heartlands Hospital Birmingham, Birmingham, UK. Warwick Medical School, University of Warwick, Coventry, UK.Arbor Research Collaborative for Health, Ann Arbor, MI, USA.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33452326

Citation

Kanda, Eiichiro, et al. "The Combination of Malnutrition-inflammation and Functional Status Limitations Is Associated With Mortality in Hemodialysis Patients." Scientific Reports, vol. 11, no. 1, 2021, p. 1582.
Kanda E, Lopes MB, Tsuruya K, et al. The combination of malnutrition-inflammation and functional status limitations is associated with mortality in hemodialysis patients. Sci Rep. 2021;11(1):1582.
Kanda, E., Lopes, M. B., Tsuruya, K., Hirakata, H., Iseki, K., Karaboyas, A., Bieber, B., Jacobson, S. H., Dasgupta, I., & Robinson, B. M. (2021). The combination of malnutrition-inflammation and functional status limitations is associated with mortality in hemodialysis patients. Scientific Reports, 11(1), 1582. https://doi.org/10.1038/s41598-020-80716-0
Kanda E, et al. The Combination of Malnutrition-inflammation and Functional Status Limitations Is Associated With Mortality in Hemodialysis Patients. Sci Rep. 2021 01 15;11(1):1582. PubMed PMID: 33452326.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The combination of malnutrition-inflammation and functional status limitations is associated with mortality in hemodialysis patients. AU - Kanda,Eiichiro, AU - Lopes,Marcelo Barreto, AU - Tsuruya,Kazuhiko, AU - Hirakata,Hideki, AU - Iseki,Kunitoshi, AU - Karaboyas,Angelo, AU - Bieber,Brian, AU - Jacobson,Stefan H, AU - Dasgupta,Indranil, AU - Robinson,Bruce M, Y1 - 2021/01/15/ PY - 2020/10/15/received PY - 2020/12/21/accepted PY - 2021/1/16/entrez PY - 2021/1/17/pubmed PY - 2021/9/15/medline SP - 1582 EP - 1582 JF - Scientific reports JO - Sci Rep VL - 11 IS - 1 N2 - 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. SN - 2045-2322 UR - https://www.unboundmedicine.com/medline/citation/33452326/The_combination_of_malnutrition_inflammation_and_functional_status_limitations_is_associated_with_mortality_in_hemodialysis_patients_ L2 - https://doi.org/10.1038/s41598-020-80716-0 DB - PRIME DP - Unbound Medicine ER -