Malnutrition and inflammation may increase the risks for bone fractures and cardiovascular events in patients undergoing hemodialysis, a new Japanese study suggests.

Malnutrition-inflammation complex syndrome (MICS) is common among patients receiving hemodialysis. In the Q-cohort study, investigators developed an easy-to-use MICS scoring system to assess MICS severity. It consists of patient age; serum creatinine, albumin, and C-reactive protein levels; and body mass index.

Among 3030 patients, bone fractures and cardiovascular events occurred in 140 and 539 patients, respectively, over a median 4 years. The median MICS score was 196. Each 10-point increase in the MICS score was associated with a significant 18%, 16%, and 15% increased risk for bone fractures, cardiovascular events, and a composite of both outcomes, respectively, corresponding author Toshiaki Nakano, MD, PhD, of the Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, and colleagues reported in Kidney Medicine.

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“Our results suggest that patients undergoing hemodialysis with a higher MICS score are at greater risk of derangement in the bone-cardiovascular axis, followed by increased incidences of CVD events and bone fractures, probably resulting in decreased activity of daily living, reduced quality of life, and augmented risk of mortality,” Dr Nakano’s team wrote.

The investigators plan to compare the predictive ability of the MICS score against the gold standard malnutrition-inflammation score (MIS). The MIS is more subjective and harder to obtain at bedside, according to the team.

Intervention is necessary to prevent bone fractures and cardiovascular events in the hemodialysis population, Dr Nakano’s team noted. Sarcopenia may be one target of intervention.

A second study, published in Clinical Kidney Journal, examined the effects of 12 weeks of intradialytic lower limb exercise in 23 older adults aged 75-95 years receiving hemodialysis who had confirmed or suspected sarcopenia. The lower limb exercises included hip flexion, hip/knee extension, hip abduction and adduction, and ankle flexion-extension and were supervised by physical activity and sport science professionals. Completers of the program experienced significant improvement in the sit-to-stand-5 test over 12 weeks (from 19.2 to 15.9 seconds) that persisted for several months after the program’s end, a team led by Sebastian Mas-Fontao, PhD, of IIS- Jiménez Díaz Foundation, Ciberdem, Madrid, Spain, reported. The exercise program also significantly improved patients’ FRIED frailty scale (1.7 to 1.1). Future trials of exercise intervention are warranted.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Yamada S, Arase H, Yoshida H, et al. Malnutrition-inflammation complex syndrome and bone fractures and cardiovascular disease events in patients undergoing hemodialysis: The Q-cohort study. Kidney Med. Published online January 10, 2022. doi:10.1016/j.xkme.2022.100408

Sánchez-Tocino ML, González-Parra E, Miranda Serrano B, et al. Evaluation of the impact of an intradialytic exercise program on sarcopenia in very elderly hemodialysis patients. Clin Kidney J. Published online February 15, 2022. doi:10.1093/ckj/sfac046