Abstract: SA-PO1082
Development and Clinical Validation of the FINE System for Sarcopenia and Nutritional Risk Screening in Patients on Hemodialysis
Session Information
- Kidney Replacement Therapy and Care Delivery Innovations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Ito, Minoru, Yabuki Byoin, Yamagata, Yamagata Prefecture, Japan
- Masakane, Ikuto, Yabuki Byoin, Yamagata, Yamagata Prefecture, Japan
Background
Our facilities employed a patient-centered strategy using the Ai-POD score to manage symptom burden in hemodialysis (HD) patients. Aging of our HD population revealed a critical gap: patients at risk for sarcopenia, falls, and fractures were not systematically identified, and fracture-related hospitalizations increased. We developed the FINE system, a two-tiered screening tool for sarcopenia and nutritional risk, to evaluate its predictive value for falls and mortality.
Methods
Primary screening evaluates sarcopenia risk (SARC-F >=4 or fall history within one year) and nutritional risk (>=2 of: BMI less than 20 kg/m2, weight loss >=1 kg in six months, CRP >=0.3 mg/dL). Patients positive for either undergo secondary screening with the 5-times sit-to-stand test (5STS; >=12 sec = motor dysfunction positive), then categorized into four groups (Figure). In June 2023, 590 HD patients (median age 69.6 years, 74% male, 46% diabetes) were followed one year. Cox regression calculated adjusted HRs using the F group as reference.
Results
Of 590 patients, 146 (24.7%) fell and 24 (4.0%) died. Group distribution: F (442, 67.7 yrs), I (10, 75.3 yrs), N (53, 68.7 yrs), E (96, 76.4 yrs). Adjusted HRs vs. F — Falls: I: 4.70 (p=0.002), N: 1.20 (p=0.553), E: 1.69 (p=0.015); Mortality: I: 5.51 (p=0.033), N: 2.21 (p=0.220), E: 0.75 (p=0.635). Notably, ~20% of F group patients experienced falls.
Conclusion
The FINE system stratified HD patients by fall and mortality risk. The I and E groups showed elevated fall risk; the I group showed markedly increased mortality. The high fall rate (~20%) in the F group suggests it includes active patients whose mobility confers fall risk — not captured by symptom-based screening. Further refinement is needed to identify this "active but at-risk" subpopulation.
Acknowledgment
English language editing assistance was provided by Claude (claude-sonnet-4-6, Anthropic; April 2026).
Overview of the FINE System screening process.