TY - JOUR
T1 - Malnutrition-Inflammation Complex Syndrome and Bone Fractures and Cardiovascular Disease Events in Patients Undergoing Hemodialysis
T2 - The Q-Cohort Study
AU - Yamada, Shunsuke
AU - Arase, Hokuto
AU - Yoshida, Hisako
AU - Kitamura, Hiromasa
AU - Tokumoto, Masanori
AU - Taniguchi, Masatomo
AU - Hirakata, Hideki
AU - Tsuruya, Kazuhiko
AU - Nakano, Toshiaki
AU - Kitazono, Takanari
N1 - Funding Information:
The Q-Cohort Study is supported by The Kidney Foundation, Japan (H19 JKFB 07-13, H20 JKFB 08-8, H23 JKFB 11-11), and the Japan Dialysis Outcome Research Foundation (H19-076-02 and H20-003), without restriction on publications.
Funding Information:
Shunsuke Yamada, MD, PhD, Hokuto Arase, MD, Hisako Yoshida, PhD, Hiromasa Kitamura, MD, Masanori Tokumoto, MD, PhD, Masatomo Taniguchi, MD, PhD, Hideki Hirakata, MD, PhD, Kazuhiko Tsuruya, MD, PhD, Toshiaki Nakano, MD, PhD, and Takanari Kitazono, MD, PhD, Research idea and study design: SY, HA, MTo; data acquisition: SY, MTa, TN, KT; data analysis interpretation: SY, HA, HY, HK, MTo, MTa; statistical analysis: SY, HY, HK; supervision or mentorship: HH, TN, KT, TK. Each author contributed important intellectual content during manuscript drafting and accepts accountability for the overall work by ensuring that questions about the accuracy or integrity of any portion of the work are appropriately investigated and resolved. The Q-Cohort Study is supported by The Kidney Foundation, Japan (H19 JKFB 07-13, H20 JKFB 08-8, H23 JKFB 11-11), and the Japan Dialysis Outcome Research Foundation (H19-076-02 and H20-003), without restriction on publications. Dr Tokumoto has received honoraria and consulting fees from Kyowa Hakko Kirin and Ono Pharmaceutical. Dr Taniguchi has received honoraria and consulting fees from Kyowa Hakko Kirin and Torii Pharmaceutical Co, Ltd. Dr Hirakata has received honoraria and consulting fees from Kyowa Hakko Kirin and Torii Pharmaceutical Co, Ltd. Dr Tsuruya has received honoraria, consulting fees, and/or grant/research support from Chugai Pharmaceutical Co, Kyowa Hakko Kirin, Bayer Yakuhin, Fuso Pharmaceutical, and Torii Pharmaceutical Co, Ltd. Dr Nakano has received honoraria, consulting fees, and/or grant/research support from Chugai Pharmaceutical Co, Kyowa Hakko Kirin, Bayer Yakuhin, Fuso Pharmaceutical, and Torii Pharmaceutical Co, Ltd. Dr Kitazono has received honoraria, consulting fees, and/or grant/research support from Mitsubishi Tanabe Pharma Co; Takeda Pharmaceutical Co, Ltd; Pfizer Japan Inc; Eizai Co, Ltd; Merck Sharp and Dohme; Astellas Pharma Inc; Novartis Pharma; Kyowa Hakko Kirin Co, Ltd; Daiichi Sankyo Co, Ltd; Otsuka Pharmaceutical Co, Ltd; Nippon Boehringer Ingelheim Co, Ltd; Torii Pharmaceutical Co, Ltd; Bristol-Myers Squibb K.K.; Sumitomo Dainippon Pharma Co, Ltd; Sanofi-Aventis K.K.; Chugai Pharmaceutical Co, Ltd; Bayer Yakuhin, Ltd; Ono Pharmaceutical Co, Ltd; Taisho Toyama Pharmaceutical Co, Ltd; Fuso Pharmaceutical Industries, Ltd; Novo Nordisk Pharm, Ltd; Teijin Pharma, Ltd; Toray Medical Co, Ltd; AbbVie GK; AstraZeneca K.K.; and Asahi Kasei Medical Co, Ltd. Drs Yamada, Arase, Yoshida, and Kitamura declare that they have no relevant financial interests. We express our sincere thanks to all the doctors and medical staff who participated in the Q-Cohort Study. The following personnel (institutions) participated in this study: Takashi Ando (Hakozaki Park Internal Medicine Clinic); Takashi Ariyoshi (Ariyoshi Clinic); Kouichiro Goto (Goto Clinic); Fumitada Hattori (Nagao Hospital); Harumichi Higashi (St Mary's Hospital); Tadashi Hirano (Hakujyuji Hospital); Kei Hori (Munakata Medical Association Hospital); Takashi Inenaga (Ekisaikai Moji Hospital); Hidetoshi Kanai (Kokura Memorial Hospital); Shigemi Kiyama (Kiyama Naika); Tetsuo Komota (Komota Clinic); Hiromasa Kuma (Kuma Clinic); Toshiro Maeda (Kozenkai-Maeda Hospital); Junichi Makino (Makino Clinic); Dai Matsuo (Hirao Clinic); Chiaki Miishima (Miishima Naika Clinic); Koji Mitsuiki (Japanese Red Cross Fukuoka Hospital); Kenichi Motomura (Motomura Naika Clinic); Sadatoshi Nakamura (Kokura Daiichi Hospital); Hidetoshi Nakamura (Kokura Daiichi Hospital); Koichi Nakashima (Ohashi Internal Circulatory Clinic); Nobumitsu Okita (Shiroishi Kyoritsu Hospital); Shinichiro Osato (Osato Jin Clinic); Sakura Sakamoto (Fujiyamato Spa Hospital); Keiko Shigematsu (Shigematsu Clinic); Kazumasa Shimamatsu (Shimamatsu Naika Iin); Yoshito Shogakiuchi (Shin-Ai Clinic); Hiroaki Takamura (Hara Hospital); Kazuhito Takeda (Iizuka Hospital); Asuka Terai (Chidoribashi Hospital); Hideyoshi Tanaka (Mojiko-Jin Clinic); Suguru Tomooka (Hakozaki Park Internal Medicine Clinic); Jiro Toyonaga (Fukuoka Renal Clinic); Hiroshi Tsuruta (Steel Memorial Yawata Hospital); Ryutaro Yamaguchi (Shiseikai Hospital); Taihei Yanagida (Saiseikai Yahata General Hospital); Tetsuro Yanase (Yanase Internal Medicine Clinic); Tetsuhiko Yoshida (Hamanomachi Hospital); Takahiro Yoshimitsu (Gofukumachi Kidney Clinic, Harasanshin Hospital); and Koji Yoshitomi (Yoshitomi Medical Clinic). We thank Kelly Zammit, BVSc, from Edanz Group (https://en-author-services.edanz.com/ac) for editing a draft of this manuscript. Received March 16, 2021. Evaluated by 2 external peer reviewers, with direct editorial input by an Associate Editor, a Statistical Editor, and the Editor-in-Chief. Accepted in revised form November 14, 2021.
Publisher Copyright:
© 2022 The Authors
PY - 2022/3
Y1 - 2022/3
N2 - Rationale & Objective: Malnutrition-inflammation complex syndrome (MICS) is common in patients receiving hemodialysis and increases the risks of morbidity and mortality. However, few studies have examined the overall impact of MICS on disorders of the bone-cardiovascular axis. Study Design: Prospective, multicenter, observational cohort study. Setting & Participants: A total of 3,030 patients receiving maintenance hemodialysis registered in the Q-Cohort Study. Predictors: A newly developed score for MICS composed of elements chosen from 8 baseline parameters related to nutrition and inflammation by bootstrap resampling, multivariable-adjusted Cox proportional hazard risk analysis for all-cause mortality, and the risk prediction rule. β-coefficients of each element analyzed in the multivariable-adjusted model were used for the creation of the MICS score. Outcomes: Bone fractures, cardiovascular disease events, and the composite outcome of bone fractures and cardiovascular disease events. Analytical Approach: Cox proportional hazard regression and Fine-Gray proportional subdistribution hazards regression. Results: During a median follow-up of 4 years, 140 patients developed bone fractures and 539 developed cardiovascular disease events. Age; serum levels of creatinine, albumin, and C-reactive protein; and body mass index were selected for the creation of the MICS score. The median (IQR) MICS score was 196 (181-212). The multivariable-adjusted Cox proportional hazard risk model and the competing risk model showed that a higher MICS score was incrementally associated with elevated risks of bone fractures, cardiovascular disease events, and the composite outcome; hazard risks (95% CIs) of fractures, cardiovascular disease events, and the composite outcome for each 10-point increase in the MICS score were 1.18 (1.01-1.38), 1.16 (1.07-1.26), and 1.15 (1.07-1.24), respectively. Limitations: One-time measurement of the parameters used for the creation of the MICS score. Conclusions: Malnutrition and inflammation represented by the MICS score were associated with increased risks of bone-cardiovascular axis disorders in patients receiving maintenance hemodialysis.
AB - Rationale & Objective: Malnutrition-inflammation complex syndrome (MICS) is common in patients receiving hemodialysis and increases the risks of morbidity and mortality. However, few studies have examined the overall impact of MICS on disorders of the bone-cardiovascular axis. Study Design: Prospective, multicenter, observational cohort study. Setting & Participants: A total of 3,030 patients receiving maintenance hemodialysis registered in the Q-Cohort Study. Predictors: A newly developed score for MICS composed of elements chosen from 8 baseline parameters related to nutrition and inflammation by bootstrap resampling, multivariable-adjusted Cox proportional hazard risk analysis for all-cause mortality, and the risk prediction rule. β-coefficients of each element analyzed in the multivariable-adjusted model were used for the creation of the MICS score. Outcomes: Bone fractures, cardiovascular disease events, and the composite outcome of bone fractures and cardiovascular disease events. Analytical Approach: Cox proportional hazard regression and Fine-Gray proportional subdistribution hazards regression. Results: During a median follow-up of 4 years, 140 patients developed bone fractures and 539 developed cardiovascular disease events. Age; serum levels of creatinine, albumin, and C-reactive protein; and body mass index were selected for the creation of the MICS score. The median (IQR) MICS score was 196 (181-212). The multivariable-adjusted Cox proportional hazard risk model and the competing risk model showed that a higher MICS score was incrementally associated with elevated risks of bone fractures, cardiovascular disease events, and the composite outcome; hazard risks (95% CIs) of fractures, cardiovascular disease events, and the composite outcome for each 10-point increase in the MICS score were 1.18 (1.01-1.38), 1.16 (1.07-1.26), and 1.15 (1.07-1.24), respectively. Limitations: One-time measurement of the parameters used for the creation of the MICS score. Conclusions: Malnutrition and inflammation represented by the MICS score were associated with increased risks of bone-cardiovascular axis disorders in patients receiving maintenance hemodialysis.
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U2 - 10.1016/j.xkme.2022.100408
DO - 10.1016/j.xkme.2022.100408
M3 - Article
AN - SCOPUS:85124159556
SN - 2590-0595
VL - 4
JO - Kidney Medicine
JF - Kidney Medicine
IS - 3
M1 - 100408
ER -
