PREVALENCE AND ASSOCIATED FACTORS OF MALNUTRITION-INFLAMMATION COMPLEX SYNDROME AMONG CHRONIC HAEMODIALYSIS PATIENTS - A SINGLE CENTRE EXPERIENCE IN SRI LANKA

Malnutrition inflammation complex syndrome (MICS) is mainly characterized by symptoms including inflammation, malnutrition and cardio-vascular disease and is especially prevalent among patients undergoing maintenance haemodialysis. It may be further exacerbated by certain factors such as body mass index, other comorbidities and socioeconomic status. Early recognition and timely treatment of MICS may help to improve the morbidity and reduce the risk of mortality. This study investigated the prevalence of MICS and its associated factors among patients on maintenance haemodialysis at National Hospital Kandy, Sri Lanka.

This study was conducted as a cross-sectional descriptive study among 131 adult patients on maintenance haemodialysis at Hanthana dialysis unit of the National Hospital, Kandy, Sri Lanka. The study was conducted over 3 months, commencing in February 2024. The patients who fulfilled the inclusion criteria and gave informed written consent were included in the study. Data was collected via an interview-administered questionnaire. The Malnutrition Inflammation Score (MIS) was used to assess MICS and its severity.

The majority of the cohort were male, 91 (69.5%), while there were 40 (30.5%) females in the studied population, and most were married (85.5%). The mean age of participants was 52.2 years (SD ±14.7, range 23–125 years). Regarding education, more than half of the patients had studied up to O/L (51.1%), while only 6.9% held a degree. In terms of occupation, a large proportion were not employed (74.8%), with 12.2% retired. Mean duration of HD therapy was  45.95 months (SD±35.57). Most of them (96.2%) underwent dialysis twice per week, with only 3.8% receiving dialysis thrice weekly. The majority of patients (91.6%) had an arteriovenous fistula (AVF) as their dialysis access, while a minority used catheters (7.6%) or grafts (0.8%). The most common co-morbidity noted in the population was Diabetes Mellitus (36.6%) followed by cardiovascular conditions. The prevalence of Ischemic Heart Disease (IHD) (26.0%) and Heart Failure (HF) (22.9%) signifies the burden of cardiovascular disease in this population. Hypertension (HTN) was present only in 24 patients out of 131( 18.3%)of the participants.

Of the 131 patients on maintenance haemodialysis, 101 (77.1%) had MICS. Out of the total population (N=131), 76 (58%) had moderate to severe MICS, while 25 (19.1%) had severe MICS. Between patients with MICS and without MICS, body mass index (BMI) (P=0.026 ) and occupation (P=0.018)were significant factors. Non-occupied and low BMI groups had a higher prevalence of MICS. Conversely, no significant associations were found for age, sex, comorbidities (DM, HTN), or haemodialysis-related factors and biochemical parameters. Total Iron Binding Capacity (TIBC) was an independent predictor of MICS [Adjusted Odds Ratio, AOR 0.170 (95% CI: 0.032 - 0.903, p < 0.05] out of the biochemical parameters. MICS is significantly associated with both body mass index (H=20.347, df=3, p<0.001) and serum albumin (H=19.847, df=3, p<0.001), and both demonstrated a significant inverse relationship with MICS score.

MICS is said to be common among patients on maintenance haemodialysis. Our study too, revealed a higher prevalence of MICS among patients on maintenance haemodialysis. Further, it was revealed that MICS status is strongly and significantly associated with compromised nutritional and inflammation markers, while dialysis parameters show no significant association. Strong association with occupation implies the socioeconomic barriers to maintaining the optimum nutrition in a low-middle-income country. Regular monitoring of TIBC and BMI will be utmost important in early detection of the presence of MICS and timely treatment to reduce the burden of associated morbidity and mortality.