A Joint Evaluation of Impaired Cardiac Sympathetic Responses and Malnutrition-Inflammation Cachexia for Mortality Risks in Hemodialysis Patients (Frontiers in Medicine)

Background: Cardiac sympathetic response (CSR) and malnutrition-inflammation syndrome (MIS) score are validated assessment tools for patients` health condition. We aim to evaluate the joint effect of CSR and MIS on all-cause and cardiovascular (CV) mortality in patients with hemodialysis (HD).Methods: Changes in normalized low frequency (?nLF) during HD were utilized for quantification of CSR. Unadjusted and adjusted hazard ratios (aHRs) of mortality risks were analyzed in different groups of ?nLF and MIS score.Results: In multivariate analysis, higher ?nLF was related to all-cause, CV and sudden cardiac deaths [aHR: 0.78 (95% confidence interval (CI): 0.72-0.85), 0.78 (95% CI: 0.70-0.87), and 0.74 (95% CI: 0.63-0.87), respectively]. Higher MIS score was associated with incremental risks of all-cause, CV and sudden cardiac deaths [aHR: 1.36 (95% CI: 1.13-1.63), 1.33 (95% CI: 1.06 - 1.38), and 1.50 (95% CI: 1.07-2.11), respectively]. Patients with combined lower ?nLF (