In maintenance hemodialysis patients, increased mortality has been associated with which nutritional profile?

• A. Low baseline body fat percentage and low muscle mass
• B. Elevated albumin and decreased CRP values
• C. Increased body mass index
• D. Decreased serum cholesterol

Answer: (A)

Protein-energy wasting with loss of body reserves is a major driver of mortality in maintenance hemodialysis. When both fat stores and muscle mass are low, there is little energy and protein available to meet the demands of chronic illness and the catabolic effects of dialysis. This depletion reflects a malnutrition-inflammatory state and is strongly linked to poorer outcomes, including higher risk of infections, frailty, and death. In contrast, higher albumin with low CRP suggests better nutritional/inflammatory status, higher BMI may be confounded by fluid status and does not reliably predict risk, and lower cholesterol can occur with malnutrition but is not as direct a marker of critical depletion as reduced fat and especially reduced muscle mass.