Incidence and risk factors of malnutrition-inflammation complex syndrome in patients receiving maintenance hemodialysis at the end stage of renal disease

doi:10.3969/j.issn.1004-583X.2026.04.004

Abstract

Abstract:

Objective To investigate the incidence of malnutrition-inflammation complex syndrome (MICS) in patients with end-stage renal disease receiving maintenance hemodialysis (MHD) and to analyze its associated risk factors, thereby providing a theoretical basis for the clinical prevention and treatment of MICS. Methods A retrospective analysis was performed on the clinical data of 108 patients who received end-stage MHD at Huanghe S&T College Affiliated Hospital and Henan Provincial People's Hospital from July 2022 to July 2025. According to the occurrence of MICS, the patients were divided into a MICS group and a non-MICS group. General data, dialysis-related data, and laboratory indicators were collected from both groups. Differences between the two groups were compared by univariate analysis, and independent risk factors were identified using a multivariate logistic regression model. Results Among the 108 patients receiving end-stage MHD, 74 were in the MICS group (68.5%) and 34 in the non-MICS group (31.5%). In terms of baseline characteristics, the MICS group was older and had a higher prevalence of diabetes mellitus than the non-MICS group (P<0.05). Regarding dialysis-related indicators, dialysis vintage was longer in the MICS group than in the non-MICS group (P<0.05). For laboratory indicators, the MICS group had lower albumin (Alb) and hemoglobin levels, but higher high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 levels than the non-MICS group (P<0.05). With the occurrence of MICS after end-stage MHD as the dependent variable (no=0, yes=1), variables with statistically significant differences in univariate analysis were assigned and included as independent variables in the model. Multivariate logistic regression showed that age ≥65 years, dialysis vintage ≥3 years, Alb <35 g/L, and hs-CRP ≥10 mg/L were independent risk factors for MICS in patients receiving end-stage MHD (P<0.05). Based on the multivariate logistic regression output, a prediction model for MICS in end-stage MHD was established: Y=0.659×age+0.435×dialysis vintage+0.578×Alb+0.701×hs-CRP-6.583. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of this model for predicting MICS in end-stage MHD was 0.878, with a specificity of 86.50% and a sensitivity of 75.69%. Conclusion The incidence of MICS in patients receiving end-stage MHD is high, reaching 68.52%. Advanced age, prolonged dialysis duration, low serum Alb, and elevated inflammatory markers are independent risk factors. The prediction model constructed on this basis demonstrates good predictive performance.

Key words: kidney failure, chronic, end-stage renal disease, maintenance hemodialysis, malnutrition-inflammation complex syndrome, risk factors

CLC Number:

R692.5

Jiang Shaoli, Yan Guosheng, Li Lili. Incidence and risk factors of malnutrition-inflammation complex syndrome in patients receiving maintenance hemodialysis at the end stage of renal disease[J]. Clinical Focus, 2026, 41(4): 312-317.

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URL: https://www.lchc.cn/EN/10.3969/j.issn.1004-583X.2026.04.004

https://www.lchc.cn/EN/Y2026/V41/I4/312

Figures/Tables 6

Tab.1 Comparison of general data between the two groups

组别	例数	性别[例(%)]				年龄(岁)		BMI(kg/m²)		合并高血压 [例(%)]		合并糖尿病 [例(%)]
组别	例数	男		女		年龄(岁)		BMI(kg/m²)		合并高血压 [例(%)]		合并糖尿病 [例(%)]
MICS组	74	42(56.8)		32(43.2)		65.93±7.25		21.00±2.49		20(27.0)		31(41.9)
非MICS组	34	19(55.9)		15(44.1)		61.22±5.56		22.05±2.88		8(23.5)		7(20.6)
χ²/ $t$ 值		0.007				3.358		1.936		0.148		4.636
$P$ 值		0.932				0.001		0.056		0.700		0.031
组别	合并高血脂 [例(%)]		原发病[例(%)]
组别	合并高血脂 [例(%)]		慢性肾小球肾炎		糖尿病肾病		高血压肾硬化		狼疮性肾炎		其他
MICS组	9(12.2)		33(44.6)		14(18.9)		9(12.2)		8(10.8)		10(13.5)
非MICS组	5(14.7)		15(44.1)		6(17.6)		5(14.7)		4(11.8)		4(11.8)
χ²/ $t$ 值	0.134		0.212
$P$ 值	0.715		0.995

Tab.1 Comparison of general data between the two groups

组别	例数	性别[例(%)]				年龄(岁)		BMI(kg/m²)		合并高血压 [例(%)]		合并糖尿病 [例(%)]
组别	例数	男		女		年龄(岁)		BMI(kg/m²)		合并高血压 [例(%)]		合并糖尿病 [例(%)]
MICS组	74	42(56.8)		32(43.2)		65.93±7.25		21.00±2.49		20(27.0)		31(41.9)
非MICS组	34	19(55.9)		15(44.1)		61.22±5.56		22.05±2.88		8(23.5)		7(20.6)
χ²/ $t$ 值		0.007				3.358		1.936		0.148		4.636
$P$ 值		0.932				0.001		0.056		0.700		0.031
组别	合并高血脂 [例(%)]		原发病[例(%)]
组别	合并高血脂 [例(%)]		慢性肾小球肾炎		糖尿病肾病		高血压肾硬化		狼疮性肾炎		其他
MICS组	9(12.2)		33(44.6)		14(18.9)		9(12.2)		8(10.8)		10(13.5)
非MICS组	5(14.7)		15(44.1)		6(17.6)		5(14.7)		4(11.8)		4(11.8)
χ²/ $t$ 值	0.134		0.212
$P$ 值	0.715		0.995

Tab.2 Comparison of dialysis-related indicators between the two groups

组别	例数	透析频率 (次/周)	透析龄 (年)	透析模式[例(%)]		spKt/V[例(%)]
组别	例数	透析频率 (次/周)	透析龄 (年)	高通量	低通量	<1.4	≥1.4
MICS组	74	2.83±0.38	4.16±0.61	40(54.0)	34(45.9)	14(18.9)	60(81.1)
非MICS组	34	2.80±0.41	3.02±0.52	17(50.0)	17(50.0)	7(20.6)	27(79.4)
χ²/ $t$ 值		0.372	9.430	0.154		0.041
$P$ 值		0.711	<0.001	0.695		0.839

Tab.2 Comparison of dialysis-related indicators between the two groups

组别	例数	透析频率 (次/周)	透析龄 (年)	透析模式[例(%)]		spKt/V[例(%)]
组别	例数	透析频率 (次/周)	透析龄 (年)	高通量	低通量	<1.4	≥1.4
MICS组	74	2.83±0.38	4.16±0.61	40(54.0)	34(45.9)	14(18.9)	60(81.1)
非MICS组	34	2.80±0.41	3.02±0.52	17(50.0)	17(50.0)	7(20.6)	27(79.4)
χ²/ $t$ 值		0.372	9.430	0.154		0.041
$P$ 值		0.711	<0.001	0.695		0.839

Tab.3 Comparison of laboratory indicators between the two groups ( x -±s)

组别	例数	Alb (g/L)	Hb (g/L)	Scr (μmol/L)	TG (mmol/L)	TC (mmol/L)	hs-CRP (mg/L)	IL-6 (pg/ml)
MICS组	74	35.80±3.15	100.23±14.63	899.65±114.76	1.68±0.31	4.16±0.47	15.93±2.44	11.32±1.57
非MICS组	34	39.72±3.24	112.66±15.71	914.63±118.95	1.70±0.30	4.20±0.48	5.32±0.48	5.12±0.33
χ²/ $t$ 值		5.953	4.006	0.623	0.315	0.408	25.072	22.742
$P$ 值		<0.001	<0.001	0.535	0.754	0.684	<0.001	<0.001

Tab.3 Comparison of laboratory indicators between the two groups ( x -±s)

组别	例数	Alb (g/L)	Hb (g/L)	Scr (μmol/L)	TG (mmol/L)	TC (mmol/L)	hs-CRP (mg/L)	IL-6 (pg/ml)
MICS组	74	35.80±3.15	100.23±14.63	899.65±114.76	1.68±0.31	4.16±0.47	15.93±2.44	11.32±1.57
非MICS组	34	39.72±3.24	112.66±15.71	914.63±118.95	1.70±0.30	4.20±0.48	5.32±0.48	5.12±0.33
χ²/ $t$ 值		5.953	4.006	0.623	0.315	0.408	25.072	22.742
$P$ 值		<0.001	<0.001	0.535	0.754	0.684	<0.001	<0.001

Tab.4 Variable assignment table

自变量	赋值
年龄	≥65岁=1,<65岁=0
合并糖尿病	是=1,否=0
透析龄	≥3年=1,<3年=0
Alb	<35 g/L=1,≥35=0
Hb	<100 g/L=1,≥100g/L=0
hs-CRP	≥10 mg/L=1,<10 mg/L=0
IL-6	≥10 pg/ml=1,<10 pg/ml=0

Tab.5 Multivariate logistic regression analysis of MICS in end-stage MHD

指标	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
指标	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	1.579	0.651	5.883	0.016	4.850	1.354	17.374
合并糖尿病	0.825	0.647	1.626	0.203	2.282	0.642	8.110
透析龄	0.943	0.332	8.068	0.005	2.568	1.339	4.922
Alb	0.627	0.223	7.905	0.005	1.872	1.209	2.898
Hb	0.897	0.610	2.162	0.142	2.452	0.742	8.106
hs-CRP	1.225	0.471	6.764	0.010	3.404	1.352	8.569
IL-6	0.780	0.658	1.405	0.237	2.181	0.601	7.922

Tab.5 Multivariate logistic regression analysis of MICS in end-stage MHD

指标	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
指标	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	1.579	0.651	5.883	0.016	4.850	1.354	17.374
合并糖尿病	0.825	0.647	1.626	0.203	2.282	0.642	8.110
透析龄	0.943	0.332	8.068	0.005	2.568	1.339	4.922
Alb	0.627	0.223	7.905	0.005	1.872	1.209	2.898
Hb	0.897	0.610	2.162	0.142	2.452	0.742	8.106
hs-CRP	1.225	0.471	6.764	0.010	3.404	1.352	8.569
IL-6	0.780	0.658	1.405	0.237	2.181	0.601	7.922

Fig.1 Prediction model for MICS in end-stage MHD

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