Kidney Medicine · Aug 18, 2026

Associations Between the Nutritional Risk Index for Japanese Hemodialysis Patients and the Risk of Bone Fractures in Patients Receiving Hemodialysis: The Q-Cohort Study

By Arase H, Yamada S, Taniguchi M et al.

RATIONALE & OBJECTIVE: Patients receiving maintenance hemodialysis have elevated fracture risk, partly owing to undernutrition and protein-energy wasting. The Nutritional Risk Index for Japanese Hemodialysis Patients (NRI-JH) has been proposed as a surrogate marker of protein-energy wasting; however, its association with fracture risk has not been evaluated. STUDY DESIGN: Multicenter, prospective cohort study. SETTING & PARTICIPANTS: This study analyzed 3,038 adults receiving maintenance hemodialysis, enrolled in the Q-Cohort Study. EXPOSURE: The baseline NRI-JH was calculated based on age, sex, body mass index, and serum levels of albumin, creatinine, and total cholesterol, and patients were categorized into 3 groups based on baseline NRI-JH values: group 1, 0-2; group 2, 3-6; and group 3, 7-13. OUTCOME: First occurrence of clinically diagnosed bone fractures. ANALYTICAL APPROACH: Incidence rates were evaluated using the Kaplan-Meier analysis. Cox proportional hazards models and Fine-Gray competing risk models (with death as a competing event) were used to estimate HRs and 95% CIs. RESULTS: During a median follow-up period of 4 years, 140 fractures occurred. Groups 2 and 3 had a significantly higher incidence of fractures than group 1 (log-rank test; P < 0.001). After multivariable adjustment, fracture risk remained higher in group 2 (HR, 1.95; 95% CI, 1.24-3.06) and group 3 (HR, 2.05; 95% CI, 1.25-3.38) than in group 1. Competing risk analyses yielded similar results. Subgroup analyses showed consistent associations across age, sex, diabetic nephropathy, inflammation, and chronic kidney disease-mineral and bone disorder parameters without significant interactions. LIMITATIONS: Single baseline measurement of exposure; lack of differentiation between fracture types; potential residual confounding. CONCLUSIONS: Higher NRI-JH values were independently associated with an increased fracture risk in patients receiving maintenance hemodialysis. The NRI-JH may serve as a comprehensive nutritional marker for identifying individuals at an elevated risk of fractures.

doi.org/10.1016/j.xkme.2026.101509 Open access PubMed 42959993 Biomarkers