Association between malnutrition–inflammation–atherosclerosis (MIA) syndrome indices and anemia in maintenance hemodialysis patients

Abstract

Anemia is a frequent complication of maintenance hemodialysis, and chronic inflammation is one of its central drivers. The malnutrition–inflammation–atherosclerosis (MIA) syndrome comprises three interacting axes that can be approximated from routine laboratory tests through the lymphocyte-to-hs-CRP ratio (LCR), the prognostic nutritional index (PNI), and the neutrophil-to-HDL-cholesterol ratio (NHR). This study examined how these three indices relate to anemia in patients on maintenance hemodialysis. We conducted a cross-sectional study of 116 patients, defining moderate anemia as a hemoglobin (Hb) concentration below 11 g/dL. Groups were compared using the t-test or Mann–Whitney test and the chi-square test, and independent associations were assessed with multivariable linear and logistic regression; the discriminatory ability of the combined model was evaluated by the area under the receiver operating characteristic curve (AUC). Anemia was present in 61 patients (52.6%). Compared with non-anemic patients, anemic patients had lower LCR and lower PNI (both p < 0.05), whereas NHR did not differ significantly. In the multivariable models, both LCR and NHR were independently associated with Hb concentration and with anemia status (all p < 0.05), while PNI lost significance after adjustment. The combined three-index model discriminated anemia with an AUC of 0.717 (95% CI, 0.63–0.81). In conclusion, LCR and NHR were relevant and consistent correlates of anemia, whereas PNI added little independent information. The combined model achieved acceptable discrimination, supporting a multi-index rather than a single-index approach when the inflammatory background of anemia is assessed in hemodialysis patients.