# Influence of infection control for COVID-19 on nutrition in relatively healthy Japanese HD patients: a retrospective observational study

## TL;DR

This study found that infection control measures for COVID-19 led to worsened nutrition in Japanese hemodialysis patients, likely due to reduced physical activity.

## Contribution

The study is the first to examine the impact of COVID-19 infection control on nutrition in hemodialysis patients using specific nutritional indices.

## Key findings

- GNRI scores decreased between February and August 2020, indicating nutritional deterioration.
- Nutritional decline was linked to higher C-reactive protein and lower hemoglobin levels, especially in urban facilities.
- Changes in body composition suggested reduced physical activity, with increased fat mass and decreased lean mass.

## Abstract

Infection control for the novel coronavirus disease 2019 (COVID-19) has been linked to decreased physical activity and nutritional deterioration in the general population; however, the influence on hemodialysis (HD) patients is not well discussed.

This multicenter retrospective study utilized the Geriatric Nutritional Risk Index (GNRI), Survival Index, and Nutritional Risk Index for Japanese HD patients (NRI-JH) to assess nutritional status and body composition over five observation periods. The primary endpoint was the body fluid removal rate (%) pre- and post-HD, whereas secondary endpoints included changes in GNRI, SI, body composition, and differences in NRI-JH.

We enrolled 139 HD patients in three facilities. The results showed a decrease in GNRI score, which indicates nutritional deterioration, between February 2020 and August 2020 (96.8 (93.2–98.9) vs. 93.8 (90.8–97.6)) (P = 0.0005). Multivariable analysis revealed that nutritional deterioration was associated with higher C-reactive protein and lower hemoglobin levels (P = 0.0004 and P = 0.0010, respectively), which were more noticeable in the urban facility. Furthermore, nutritional deterioration was linked to a decrease in soft lean and somatic cell mass and an increase in body fat mass, suggesting reduced physical activity.

Nutritional deterioration was observed shortly after the first COVID-19 outbreak, suggesting an association with decreased physical activity.

The online version contains supplementary material available at 10.1007/s10157-025-02638-3.