Protein-energy wasting and its association with 1-year mortality and morbidity in hemodialysis patients: the predictive utility of nutritional scores

Background Malnutrition remains a prevalent and critical concern among patients undergoing maintenance hemodialysis (HD), with no single parameter reliably predicting its adverse outcomes. This study aimed to evaluate the prevalence of protein-energy wasting (PEW) and its impact on dialysis-related morbidities and 1-year mortality. Patients and methods A total of 104 prevalent HD patients were followed over 1 year. Comprehensive clinical and laboratory evaluations were conducted, including assessments of inflammatory markers. Nutritional status was assessed using a combination of biochemical indices, anthropometry, bioelectrical impedance analysis, and standardized nutritional scoring systems. Patients were monitored for hospitalization, dialysis-related complications, and all-cause mortality. Results According to the International Society of Renal Nutrition and Metabolism (ISRNM) criteria, PEW was identified in 22.1% of the cohort. Patients with PEW exhibited significantly lower serum phosphorus, creatinine, hemoglobin, total protein, cholesterol, albumin, prealbumin, and dialysis adequacy compared with non-PEW counterparts. Conversely, higher levels of ferritin, high-sensitivity C-reactive protein, dialysis-related complications, hospitalization, and mortality were observed in the PEW group. PEW was more prevalent among patients with permanent dialysis catheters. Among deceased patients, lower values of albumin, prealbumin, Kt/V, bone mass, mid-arm, and waist circumferences along with elevated high-sensitivity C-reactive proteinwere noted. Multivariate logistic regression identified the ISRNM score as an independent predictor of mortality. Conclusion Protein-energy wasting significantly increases the risk of morbidity and mortality in HD patients. The ISRNM score offers a valuable tool for identifying high-risk individuals and predicting mortality.