Abstract
Modified creatinine (Cr) index, calculated by age, sex, pre-dialysis serum Cr concentration, and Kt/V for urea, is an indicator of skeletal muscle mass in hemodialysis (HD) patients. It remains unknown whether the modified Cr index predicts infection-related mortality in this population. We investigated the association between the modified Cr index and infection-related mortality. A total of 3046 patients registered in the Q-Cohort Study, a multicenter, observational study of HD patients, were analyzed. Associations between sex-specific quartiles (Q1–Q4) of the modified Cr index and the risk for infection-related mortality were analyzed by Cox proportional hazard model. During a median follow-up of 8.8 years, 387 patients died of infection. The estimated risk for infection-related mortality was significantly higher in the lower quartiles (Q1, Q2, and Q3) than in the highest quartile (Q4) as the reference group (hazard ratios and 95% confidence intervals [CI]: Q1, 2.89 [1.70–5.06], Q2, 2.76 [1.72–4.62], and Q3, 1.79 [1.12–2.99]). The hazard ratio (95% CI) for a 1 mg/kg/day decrease in the modified Cr index was 1.18 (1.09–1.27, P < 0.01) for infection-related mortality. In conclusion, a lower modified Cr index is associated with an increased risk for long-term infection-related mortality in the HD population.
Highlights
Modified creatinine (Cr) index, calculated by age, sex, pre-dialysis serum Cr concentration, and Kt/V for urea, is an indicator of skeletal muscle mass in hemodialysis (HD) patients
In the present cohort study of patients on maintenance HD, we demonstrated that the modified Cr index was significantly associated with nutritional markers including serum albumin concentration and body mass index (BMI), both of which are included in the protein energy wasting (PEW) criteria
Our study suggests that the modified Cr index, an indicator of skeletal muscle mass, can be used as a nutritional marker of HD patients, which predicts long-term prognosis of infectious mortality in this population
Summary
Modified creatinine (Cr) index, calculated by age, sex, pre-dialysis serum Cr concentration, and Kt/V for urea, is an indicator of skeletal muscle mass in hemodialysis (HD) patients. It remains unknown whether the modified Cr index predicts infection-related mortality in this population. We recently reported that a lower modified Cr index was significantly associated with higher risks for bone fracture, heart disease, and all-cause mortality from the 4-year follow-up data of the Q-Cohort Study[9,10]. The aim of the present study was to investigate the relationship between estimated skeletal muscle mass, shown by the modified Cr index, and long-term infection-related mortality in HD patients by analyzing the 10-year follow-up data of the Q-Cohort Study. We determined the predictive value of the modified Cr index using c-statistics, net reclassification improvement (NRI), and integrated discrimination improvement (IDI)
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