Medical, social and demographic factors related to malnutrition and inflammation score in hemodialisis patients

Introduction and Purpose The incidence of end-stage renal disease (ESRD) patients requiring dialysis is steadily increasing. Worldwide and in our country, the most significant risk factors related to mortality in hemodialysis patients have been identified as comorbid diseases such as coronary artery disease, diabetes mellitus, and hypertension. It is known that another important risk factor for mortality in hemodialysis patients is protein-energy malnutrition, which is observed in 23-76% of patients. Generally, malnutrition and inflammation are commonly coexistent in 50-75% of hemodialysis patients. The malnutrition-inflammation score (MIS) is one of the methods used to identify the malnutrition status and predict mortality rates in hemodialysis patients. In this study, our goal is to identify medical parameters and sociodemographic factors that may be associated with the malnutrition-inflammation score (MIS) beyond well-known clinical parameters affecting MIS and quality of life in end-stage renal disease patients undergoing hemodialysis (ESRD-HD). By doing so, we aim to conduct a study that contributes to improving the quality of life and extending the lifespan of hemodialysis patients through medical and social measures that target the prevention or correction of these identified parameters. Materials and Methods Our study was cross-sectional and conducted with 80 voluntary patients aged 18 and over who have been undergoing routine hemodialysis for six months or longer at Erzincan Binali Yıldırım University Mengücek Gazi Training and Research Hospital Hemodialysis Unit and a private hemodialysis center in Erzincan. The routine biochemical parameters of the patients were calculated based on the six-month averages between January 01, 2023, and June 30, 2023. In addition to the identified parameters known to affect the malnutrition-inflammation score, other biochemical values, sociodemographic factors, and medical parameters that we anticipated might be effective were analyzed. Pre-dialysis and post-dialysis systolic and diastolic blood pressure measurements, waist and hip circumferences, height, weight, body mass index, and upper arm circumference measurements were taken at 5 the hemodialysis center. Device settings, session details, and administered treatments during hemodialysis were recorded. The SF-36 questionnaire was administered to patients at the dialysis center. Findings When correlation analysis was conducted between the malnutrition-inflammation score (MIS) values of the 80 patients included in the study and demographic parameters, a significant negative correlation was found between MIS and body weight, BMI, waist circumference, hip circumference, and upper arm circumference. Among the parameters related to quality of life, the group of patients with sleep disorders had a higher MIS value compared to the group without sleep disorders. Negative correlations were observed between MIS and vitamin D dose (mcg/month), heparin dose (unit/session), ALT, magnesium, ferritin, TIBC, albumin, and total cholesterol levels, while positive correlations were found between MIS and CRP and LDL cholesterol levels. According to the correlation analysis between the subparameters of the SF-36 Scoring System and the total MIS score, a significant negative correlation was found between MIS and physical function score and pain score, while no statistically significant relationship was found among other subparameters. When the parameters with a statistically significant relationship with the MIS score were analyzed for correlation with SF-36 subparameters, a negative correlation was found between albumin levels and energy/vitality score, a positive correlation was found between magnesium levels and physical function score and mental health score, and a negative correlation was found between TIBC and physical role limitations, emotional role limitations, general health, and energy/vitality scores. An increase in the recovery time after dialysis was associated with a positive correlation with physical role limitations, an increase in the number of people at home was associated with a positive correlation with mental health score, and the total time patients spent on dialysis was associated with a positive correlation with social functioning score. No statistically significant relationship was found among other categories. Discussion In our study, we evaluated medical, social, and demographic factors associated with the malnutrition-inflammation score (MIS) in hemodialysis patients, the relationship between the malnutrition-inflammation score and quality of life, and the association of parameters found to be significant for the malnutrition-inflammation score with the subparameters of the quality of life scale. Our study identified significant relationships between MIS and evaluated 6 factors within the MIS system, including body weight, BMI, TIBC, and albumin levels, as well as sleep disorders, vitamin D dose, heparin dose, magnesium, ferritin, CRP, total cholesterol, and LDL cholesterol levels. The study also found significant relationships between MIS and the subparameters of the SF-36 scoring system, specifically the physical function and pain scores. This comprehensive assessment highlights the need for multifaceted evaluation in the follow-up and treatment of hemodialysis patients to reduce morbidity and mortality, and enhance the quality of life. The correlation found between the active vitamin D dose and the malnutrition-inflammation score (MIS) suggests that vitamin D may suppress the inflammatory process, improve patient performance, and enhance the quality of life. The positive correlation between heparin dose and MIS implies that, in addition to its role in the coagulation cascade, heparin may contribute positively to reducing mortality rates in hemodialysis patients by suppressing inflammation. The significant elevation of MIS in patients with magnesium levels below 2.5 mg/dl and the positive correlation between magnesium levels and physical function and mental health scores suggest that monitoring magnesium levels closely and implementing appropriate treatments could improve patient prognosis and quality of life in hemodialysis patients. In our study, the negative correlation between serum ferritin levels and MIS highlights the need for multicenter, prospective studies with a larger number of patients to determine optimal ferritin levels and investigate the impact of ferritin on mortality in hemodialysis patients. The improvement of the quality of life in hemodialysis patients will indirectly affect the malnutrition-inflammation score by addressing the nutritional status. In the monitoring of dialysis patients, it is crucial to assess the subparameters of the SF-36 scale that evaluate the quality of life and aim to correct those with low scores. Identifying and addressing modifiable factors with a significant direct or indirect relationship with the malnutrition-inflammation score among the parameters we examined in our study is believed to assist in reducing mortality and morbidity in hemodialysis patients by implementing timely corrective measures. The evaluation of various parameters associated with the malnutrition-inflammation score (MIS), which has been demonstrated in numerous studies to be related to mortality in hemodialysis patients, through multicenter studies and long-term patient follow-up will 7 contribute to the development of new methods to reduce mortality in dialysis patients. There is a need for extensive and prospective studies on this topic with broad participation.