Inflammatory markers predict MIA syndrome progression and cardiovascular disease outcomes in maintenance dialysis patients

Abstract

Objective: To investigate associations between inflammatory markers and malnutrition-inflammation-atherosclerosis (MIA) syndrome in dialysis patients and evaluate their predictive value for cardiovascular events. Methods: This retrospective cohort study enrolled 197 maintenance dialysis patients (2017–2022). Inflammatory markers (CRP, IL-6, TNF-α), nutritional parameters, and atherosclerosis indicators were collected at baseline, 6, 12, and 24 months. Multivariate regression and Cox models assessed associations with MIA syndrome and cardiovascular outcomes. Results: Elevated inflammatory markers were significantly associated with MIA syndrome severity and cardiovascular events (P < 0.001). High-inflammation patients had higher MIA scores (8.7 ± 2.1 vs. 6.4 ± 1.9, P < 0.001). CRP correlated negatively with albumin (r=-0.41) and positively with carotid intima-media thickness (r = 0.36, both P < 0.001). Hemodialysis patients showed higher CRP levels (8.2 ± 4.4 vs. 6.1 ± 3.7 mg/L, P = 0.011) and cardiovascular event rates (46.3% vs. 29.2%, P = 0.027) than peritoneal dialysis patients. Inflammatory changes correlated with MIA progression (r = 0.37, P < 0.001). After adjustment, CRP (HR = 1.17, 95% CI: 1.08–1.26), IL-6 (HR = 1.12, 95% CI: 1.04–1.20), and TNF-α (HR = 1.14, 95% CI: 1.05–1.23) independently predicted cardiovascular events. Conclusion: Inflammatory markers independently associate with MIA syndrome and cardiovascular events in dialysis patients. Hemodialysis patients demonstrate greater inflammatory burden than peritoneal dialysis patients, with inflammation potentially mediating this difference. Findings support inflammatory monitoring for risk stratification and targeted interventions.