Associations between anthropometric, biochemical, and clinical factors and nutritional status in hemodialysis patients: an exploratory cross-sectional analysis

BACKGROUND: This study aimed to investigate the associations and explore direct pathways between anthropometric measurements, biochemical parameters, and clinical characteristics in relation to nutritional status, assessed by Subjective Global Assessment (SGA), in patients undergoing maintenance hemodialysis (HD). METHODS: This cross-sectional study included 93 adult HD patients recruited from a tertiary university hospital. Nutritional status was assessed using the SGA. Anthropometric measurements and biochemical parameters were evaluated. Group comparisons were performed using ANOVA and Chi-square tests. Univariate and multivariate logistic regression analyses were conducted to identify predictors of malnutrition, and exploratory path analysis was applied to examine patterns of association between selected clinical, anthropometric measurements, and nutritional status. Statistical significance was set at p < 0.05. RESULTS: According to the SGA, 68.8% of patients were classified as well-nourished; the mean age was 61.0 ± 14.1 years, and the mean Body Mass Index (BMI) was 25.0 ± 4.3 kg/m². Gender, multimorbidity (p < 0.05), older age, longer HD duration, and higher CRP levels (p < 0.001) were positively associated with malnutrition risk, while albumin and hemoglobin (p < 0.001) were negatively associated. In multivariate logistic regression analysis [OR (95% CI)], BMI (OR: 0.662, 95% CI: 0.445-0.985), serum albumin (OR: 0.03, 95% CI: 0.003-0.402), and hemoglobin (OR: 0.293, 95% CI: 0.112-0.761) were significant predictors of malnutrition risk (p < 0.05). In an exploratory path model accounting for 36% of the variance in SGA-defined nutritional status (R² = 0.36), BMI, age, and HD duration demonstrated significant standardized associations (β = -0.39, β = 0.30, and β = 0.31, respectively; all p < 0.001). CONCLUSIONS: Anthropometric measurements, routinely available biochemical parameters, and clinical characteristics provide complementary information for the assessment of nutritional status in patients undergoing maintenance HD. Age, HD duration, multimorbidity, and BMI emerged as clinically relevant factors associated with malnutrition risk across complementary analytical approaches. TRIAL REGISTRATION: This research is a clinical assessment conducted on human participants but does not require intervention.