Abstract: SA-PO1047
Inflammation and Nutritional Status as Determinants of Biological Vulnerability in Patients Receiving Outpatient Hemodialysis: Prognostic Value of Prognostic Nutritional Index and C-Reactive Protein (CRP)-to-Albumin Ratio
Session Information
- Hemodialysis: Risk Factors, Epidemiology, and Outcomes
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
- Martinez Vaquera, Shaira, Diaverum Spain, Renal Services, Madrid, Spain
- Molina, Sonia Caparros, Diaverum Spain, Renal Services, Madrid, Spain
- Lupiañez-Barbero, Ascension, Diaverum Spain, Renal Services, Madrid, Spain
Background
Chronological age inadequately reflects biological vulnerability in maintenance hemodialysis (HD). Chronic inflammation and protein-energy wasting contribute to frailty and adverse outcomes. We evaluated the prognostic value of the Prognostic Nutritional Index (PNI) and C-reactive protein-to-albumin ratio (CAR) as markers of vulnerability in outpatient HD patients.
Methods
Retrospective observational study including longitudinal data from outpatient HD centers between January 2015 and September 2021. A total of 4,394 patient records were analyzed across age strata. PNI and CAR were calculated as markers of immunonutritional and inflammatory status. Polynomial regression identified inflection points according to age. Associations with functional dependency and hospitalization were evaluated using correlation and multivariable analyses.
Results
An inflection point was identified around 65 years, characterized by a significant decline in PNI (p<0.0001) and progressive increase in CAR (mean 0.40±0.6). Patients with PNI <35 had higher odds of functional dependency (OR 3.1; p<0.01). Among patients older than 75 years, CAR showed better discrimination for hospitalization risk than isolated CRP levels, supporting the additional prognostic value of hypoalbuminemia within the inflammatory setting.
Conclusion
Inflammatory and immunonutritional biomarkers are strongly associated with biological vulnerability and frailty in HD patients beyond chronological age. Combined assessment of PNI and CAR may improve early risk stratification and identify patients who could benefit from targeted interventions, including nutritional support, exercise programs, and intensified follow-up. Their low cost and wide availability support their use in routine outpatient HD care.