Prevalence and influencing factors of malnutrition in maintenance hemodialysis patients in China: a systematic review

TL;DR

This study finds that nearly half of hemodialysis patients in China are malnourished, identifying key factors like age, BMI, and dialysis frequency that contribute to this issue.

Contribution

The study provides a systematic review and meta-analysis of malnutrition prevalence and its influencing factors in Chinese hemodialysis patients.

Findings

The overall incidence of malnutrition in MHD patients is 46.9%.

Age, BMI, dialysis vintage, and serum C-reactive protein are significant factors influencing malnutrition.

Individualized interventions targeting these factors are needed to improve patient outcomes.

Abstract

The number of patients with chronic kidney disease (CKD) continues to rise in China, where maintenance hemodialysis (MHD) is a primary treatment. However, long-term hemodialysis is frequently associated with malnutrition, which severely compromises patients’ quality of life and prognosis.

To systematically evaluate the incidence and influencing factors of malnutrition in MHD patients by using Meta-analysis methods, thereby providing a basis for early clinical identification and intervention.

We systematically searched PubMed, Web of Science, the Cochrane Library, CINAHL, China National Knowledge Infrastructure (CNKI), VIP, Wan Fang Data and SinoMed. The search covered the period from database inception to October 10, 2025, for studies investigating factors influencing malnutrition in MHD patients. Data were analyzed using Stata 15.0. A random-effects model was applied in cases of substantial heterogeneity (I2 ≥ 50%), otherwise a fixed-effects model was used. Publication bias was assessed using Egger’s test, and the trim-and-fill method was employed if necessary.

A total of 26 studies involving 5,055 patients were included, and the overall incidence of malnutrition in MHD patients was 46.9% (95% CI: 41.8–52%). Meta-analysis showed that age (OR = 1.509), body mass index (BMI) (OR = 1.544), dialysis vintage (OR = 2.265), urea clearance index (Kt/V) (OR = 2.019), serum C-reactive protein (CRP) (OR = 3.013), high-sensitivity C-reactive protein (hs-CRP) (OR = 2.104), protein intake (OR = 3.018), frequency of dialysis (OR = 2.100), depression (OR = 2.671), anxiety (OR = 2.531), monthly household income (OR = 1.563), serum albumin (ALB) (OR = 1.115), frequency of erythropoietin (EPO) use (OR = 1.506) and duration of dialysis per session (OR = 1.879) were the main influencing factors (p < 0.05).

Malnutrition is present in 46.9% of maintenance hemodialysis patients. Individualized assessment and intervention targeting these key factors are essential to improve nutritional status and patient prognosis.

https://www.crd.york.ac.uk/PROSPERO/, registration no. CRD42024596946.

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