Association between inflammatory indices reflecting the three axes of the malnutrition-inflammation-atherosclerosis (MIA) syndrome and anemia status 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 reflected by routine surrogate indices: 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.