ASSOCIATION OF MALNUTRITION–INFLAMMATION STATUS WITH CARDIOVASCULAR HOSPITALIZATION IN MAINTENANCE HEMODIALYSIS PATIENTS: AN EVALUATION OF MALNUTRITION INFLAMMATION SCORE, MUSCLE MASS, FAT MASS, AND MUSCLE STRENGTH

FAJARAI, BIRGITTA and Ali, Zulkhair and Liberty, Iche Andriyani (2025) ASSOCIATION OF MALNUTRITION–INFLAMMATION STATUS WITH CARDIOVASCULAR HOSPITALIZATION IN MAINTENANCE HEMODIALYSIS PATIENTS: AN EVALUATION OF MALNUTRITION INFLAMMATION SCORE, MUSCLE MASS, FAT MASS, AND MUSCLE STRENGTH. Other thesis, Sriwijaya University.

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Abstract

Background: End-stage renal disease (ESRD) patients undergoing maintenance hemodialysis have a high risk of cardiovascular morbidity and mortality. The malnutrition–inflammation syndrome (MIS), reflecting a combination of protein–energy wasting and chronic inflammation, contributes substantially to this risk. Assessment of MIS using the Malnutrition Inflammation Score (MIS) can be complemented with measurements of muscle mass (appendicular skeletal muscle mass index, ASMI), fat mass (fat mass index, FMI), and handgrip strength (HGS) to provide a comprehensive evaluation of nutritional and muscle function status. Methods: This retrospective cohort study included 169 ESRD patients receiving maintenance hemodialysis twice weekly for ≥3 months at Mohammad Hoesin Hospital, Palembang, between January and July 2025. MIS, ASMI, FMI, and HGS were assessed at baseline. Unplanned cardiovascular hospitalizations (acute pulmonary edema, ischemic heart disease, stroke, or hypertensive crisis) within the subsequent 6 months were recorded. Bivariate analysis and multivariate Cox proportional hazards regression were performed to identify independent predictors. Results: Of the 169 patients (48.52% male; median age 52 years, range 19–77), a total of 131 cardiovascular hospitalization events occurred in 71 patients (42.01%), corresponding to an overall incidence of 129.2 per 1000 patient-months. The highest incidence was observed in the high MIS category (290.8 per 1000 patient-months). Bivariate analysis showed significant associations between cardiovascular hospitalization and moderate MIS (p=0.037), high MIS (p<0.001), and low HGS (p=0.011), whereas low ASMI and low FMI were not significant (p=0.465 and p=0.078). In the multivariate model, moderate MIS (aHR=2.87; 95% CI 1.22–6.73; p=0.016) and high MIS (aHR=6.25; 95% CI 2.55–15.32; p<0.001) remained independent predictors, while low HGS lost significance. Conclusion: Moderate and high MIS are independent predictors of cardiovascular hospitalization over a six-month period in maintenance hemodialysis patients, demonstrating superior predictive ability compared with body composition or muscle strength parameters. Keywords: Maintenance hemodialysis, malnutrition–inflammation, muscle mass, fat mass, muscle strength, cardiovascular hospitalization.

Item Type:	Thesis (Other)
Uncontrolled Keywords:	Malnutrition, Inflammation, Malnutrition-Inflammation Status, Malnutrition Inflammation Score, Cardiovascular Hospitalization, Hemodialysis Patients, Maintenance Hemodialysis, Muscle Mass, Fat Mass, Muscle Strength
Subjects:	R Medicine > RC Internal medicine > RC31-1245 Internal medicine R Medicine > RC Internal medicine > RC620-627 Nutritional diseases. Deficiency diseases R Medicine > RC Internal medicine > RC666-701 Diseases of the circulatory (Cardiovascular) system R Medicine > RC Internal medicine > RC870-923 Diseases of the genitourinary system. Urology R Medicine > RC Internal medicine > RC925-935 Diseases of the musculoskeletal system
Divisions:	04-Faculty of Medicine > 11702-Internal Medicine (Sp
Depositing User:	Birgitta Fajarai
Date Deposited:	16 Sep 2025 01:32
Last Modified:	16 Sep 2025 01:32
URI:	http://repository.unsri.ac.id/id/eprint/183857

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