Relationship between Malnutrition-Inflammation Complex Syndrome and Fluid Balance in Maintenance Hemodialysis Patients

The aim of this study was to assess the prevalence of malnutrition-inflammation complex syndrome (MICS) and determine sensitivity and specificity of MICS markers in hemodialysis (HD) patients depending on volume status. The study included 124 patients undergoing adequate HD. The patients were distributed based on IDWG (interdialytic weight gain)/DBW (dry body weight) and IDWG/ TBW (total body water) ratios in 4 groups: 1 – IDWG/DBW ≤ 5%and IDWG/TBW ≤10%; 2 – IDWG/DBW ≤5% and IDWG/TBW >10%; 3 – IDWG/DBW >5% and IDWG/TBW ≤10%, and 4 – IDWG/DBW > 5% and IDWG/TBW > 10%. MICS was evaluated based on malnutrition and inflammation markers. Data were analyzed with ANOVA, chi-square test, R.O.C. curve and Odds ratio, using SPSS software; p <0.05 was considered statistically significant. A significant difference was found in patients’ distribution pattern according to IDWG/DBW and IDWG/TBW ratios (p <0.0001). The rate of volume overload, represented with IDWG/TBW >10%, was significantly higher in patients in groups 3 and 4. Groups also differed in age (F=3.3, p <0.02) and residual diuresis (F=2.3, p <0.05). In spite of different volume status, systolic and diastolic blood pressure did not differ significantly between groups. Serum sodium (p <0.043) and chloride (p <0.035) differed significantly between groups patients in group 1 had highest, while patients in group 4 had lowest sodium and chloride levels. CRP levels did not differ significantly between groups. The highest prevalence of MICS was found in group 4 (up to 30%). BMI had strongest predictive value for MICS in groups 1 and 4 (p = 0.000 and p = 0.002 respectively), followed by malnutrition-inflammation score, MIS (p = 0.053 and p = 0.057 respectively). Ferritin and BMI were the strongest predictors of MICS in group 3 (p = 0.023 and p = 0.051 respectively). Patients in group 4 had three times higher chances to have MICS then those in group 3 (OR = 3, CI: 1.7645 < O.R. < 5.1007). In this study, the excessive volume overload implied increased risk and high prevalence of MICS. Low BMI and MIS appeared to be the most sensitive predictors of MICS, while low BMI also represented strong risk factor for disturbed fluid balance.