Malnutrition-inflammation-fluid overload complex syndrome and all-cause mortality in patients undergoing hemodialysis

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.

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.

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.

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.