Abstract: Objective To analyze the relationship between the modified creatinine index (mCI) level and prognosis in maintenance hemodialysis (MHD) patients, and to explore the effect of longitudinal changes of mCI on all-cause mortality in MHD patients. Methods The study was a retrospective cohort study. Patients who underwent hemodialysis at Hangzhou Hospital of Traditional Chinese Medicine between March 2017 and June 2017 were enrolled. Base on longitudinal changes in mCI over one year from baseline, patients were divided into an mCI decline group and an mCI non-decline group. The outcome was all-cause mortality, with follow-up ending on June 30, 2023. The Kaplan-Meier method and Cox proportional hazards model were used to analyze the effect of longitudinal changes in mCI on all-cause death. Results A total of 211 patients were included, with an mean age of (61.17±13.74) years. There were 91 patients in the mCI decline group and 120 in the non-decline group. The median follow-up time was 72 (QR: 43, 75) months. Kaplan-Meier curve analysis showed that the risk of death was higher in the mCI decline group than that in the non-decline group (Log rank χ2=5.991, P=0.014). After adjusting for confounding factors using the Cox proportional hazards model, the trend of mCI change remained an independent risk factor for all-cause death, even after adjustment for baseline mCI. The risk of all- cause death in the decline group was 2.149 times that in the non- decline group (95% CI: 1.236～3.734, P=0.007). Conclusions In MHD patients, a decline in mCI is associated with an increased risk of all-cause mortality. The longitudinal trend of mCI should be monitored dynamically, and timely interventions should be  implemented to improve prognosis.

Key words: Renal dialysis, Modified creatinine index, Prognosis, All-cause mortality