Abstract
BACKGROUND: In patients undergoing hemodialysis, functional dependence has increasingly been recognized as a critical factor influencing both quality of life and clinical outcomes. This study evaluates the combined effect of the Geriatric Nutritional Risk Index (GNRI) and Modified Creatinine Index (mCI) on predicting functional dependence in patients undergoing maintenance hemodialysis (MHD). METHODS: We conducted a cross-sectional survey at the Second Affiliated Hospital of Soochow University from June to December 2023. The study involved 208 MHD patients whose functional status was assessed using Katz and Lawton-Brod questionnaires. Patients were classified into either a normal functional group or a functional dependence group based on their scores. GNRI and mCI were categorized using cut-off values of 98.0 and 21.63 mg·kg(- 1)·d(- 1), respectively. Logistic regression analysis was used to evaluate the risk factors and develop predictive models. The accuracy of these models was assessed through receiver operating characteristic (ROC) curves. RESULTS: Functional dependence was observed in 110 patients (52.9%). The functional dependence group exhibited significantly higher age, prevalence of diabetes, and pulse pressure, but lower diastolic blood pressure, serum creatinine, serum albumin, cholesterol, GNRI, and mCI compared to the normal functional group (all P < 0.05). Logistic regression highlighted significant differences in the risk of functional dependence among the four groups based on GNRI and mCI thresholds (P < 0.05). The area under the curve (AUC) for the combined GNRI and mCI model was 0.708 (95% CI 0.638-0.778, P < 0.001), indicating superior predictive capability over the individual indices (GNRI alone AUC = 0.657, mCI alone AUC = 0.682). CONCLUSION: GNRI and mCI, when used in combination, provide a more effective prediction of functional dependence in MHD patients than when used separately.