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Kidney Week

Abstract: PO2038

The Combination of Malnutrition Inflammation and Limitations in Functional Status Is Associated with a Very High Risk of Mortality in Hemodialysis Patients: Results from the DOPPS

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1300 Health Maintenance, Nutrition, and Metabolism


  • Lopes, Marcelo, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Kanda, Eiichiro, Kawasaki Ika Daigaku, Kurashiki, Okayama, Japan
  • Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Tsuruya, Kazuhiko, Nara-ken, Nara, Nara, Japan
  • Hirakata, Hideki, Fukuoka Renal Clinic, Fukuoka, Japan
  • Karaboyas, Angelo, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Jacobson, Stefan H., Karolinska Institutet, Stockholm, Stockholm, Sweden
  • Dasgupta, Indranil, University of Warwick Warwick Medical School, Coventry, Coventry, United Kingdom
  • Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Pecoits-Filho, Roberto, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Group or Team Name


The malnutrition-inflammation-complex (MIC) is a risk factor for mortality and lower quality of life in hemodialysis (HD) patients. The identification of MIC and its risk factors, which include the limited ability to perform functional status (FS), is key to improve the patient experience on HD. Our study investigates the association of MIC and FS combinations with mortality in HD patients,


We analyzed data from a cohort of 5465 HD patients from Australia, France, Germany, Italy, Japan, New Zealand, Spain, Sweden, and United Kingdom, enrolled in the Dialysis Outcomes and Practice Patterns Study phases 4 (2009-2011) and 5 (2012-2015). MIC syndrome was defined as low serum albumin (<3.8 g/dL) and high serum C-reactive protein (>3mg/L in Japan; >10 mg/L elsewhere). Poor functional status was defined as the sum of scores from the self-reported limitations in the Katz Index of Independence in Activities of Daily Living (0 to 5) and the Lawton-Brody Instrumental Activities of Daily Living Scale (score ranges from 0 to 8) less than 11. We investigated the association between combinations of MIC (+/-) and FS (low/high) with death, using Cox proportional hazards models adjusted for possible confounders including patient demographics, comorbidity history, catheter use, serum creatinine, phosphorus levels, WBC count, hemoglobin level, and time on dialysis therapy.


The prevalence of different combinations were: MIC-/High FS 57%, MIC-/Low FS 24%, MIC+/High FS 9%, and MIC+/Low FS 10%. Patients with MIC-/high FS were younger, better nourished, and had lower prevalence of comorbidities. Compared to the reference group, the hazard ratios [HR (95% CI)] for all-cause mortality were 1.56 (1.24-1.98) for MIC-/ low FS, 1.75 (1.32-2.32) for MIC+/ high FS, and 2.97 (2.31-3.82) for MIC+/ low FS groups. The adjusted HRs for infection-related mortality were 1.57 (0.91, 2.71) for MIC-/low FS, 1.67 (0.84, 3.31) for MIC+/High FS, and 5.45 (3.15, 9.45) for MIC+/low FS groups.


The combination of MIC and low FS is a strong predictor of mortality, and infectious mortality in particular, in HD patients. Identification of patients with MIC and FS.