The identification of malnutrition-inflammation-complex (MIC) and functional status (FS) is key to improving patient experience on hemodialysis (HD). We investigate the association of MIC and FS combinations with mortality in HD patients. We analyzed data from 5630 HD patients from 9 countries in DOPPS phases 4–5 (2009–2015) with a median follow-up of 23 [IQR 11, 31] months. MIC was defined as serum albumin < 3.8 g/dL and serum C-reactive protein > 3 mg/L in Japan and > 10 mg/L elsewhere. FS score was defined as the sum of scores from the Katz Index of Independence in Activities of Daily Living and the Lawton-Brody Instrumental Activities of Daily Living Scale. We investigated the association between combinations of MIC (+/−) and FS (low [< 11]/high [≥ 11]) with death. Compared to the reference group (MIC−/high FS), the adjusted hazard ratios [HR (95% CI)] for all-cause mortality were 1.82 (1.49, 2.21) for MIC−/low FS, 1.57 (1.30, 1.89) for MIC+/high FS, and 3.44 (2.80, 4.23) for MIC+/low FS groups. Similar associations were observed with CVD-related and infection-related mortality. The combination of MIC and low FS is a strong predictor of mortality in HD patients. Identification of MIC and poor FS may direct interventions to lessen adverse clinical outcomes in the HD setting.

营养不良-炎症-复合物 (MIC) 和功能状态 (FS) 的识别是改善患者血液透析 (HD) 体验的关键。我们调查了 MIC 和 FS 组合与 HD 患者死亡率的关联。我们分析了来自 9 个国家的 5630 名处于 DOPPS 4-5 期（2009-2015 年）的 HD 患者的数据，中位随访时间为 23 [IQR 11, 31] 个月。MIC 被定义为血清白蛋白 < 3.8 g/dL 和血清 C 反应蛋白 > 3 mg/L，在日本和在其他地方 > 10 mg/L。FS 得分定义为 Katz 日常生活活动独立性指数和 Lawton-Brody 日常生活活动量表的得分总和。我们研究了 MIC (+/-) 和 FS（低 [< 11]/高 [≥ 11]）的组合与死亡之间的关联。与参考组（MIC-/high FS）相比，MIC-/低 FS 的全因死亡率调整后风险比 [HR (95% CI)] 为 1.82 (1.49, 2.21)，MIC+/高 FS 为 1.57 (1.30, 1.89) 和 3.44 (2.80, 4.23)适用于 MIC+/低 FS 组。观察到类似的关联与 CVD 相关和感染相关的死亡率。MIC 和低 FS 的组合是 HD 患者死亡率的强预测因子。识别 MIC 和较差的 FS 可能会指导干预措施，以减少 HD 环境中的不良临床结果。