{ "abstract": "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. Plain-Language Summary: Patients receiving maintenance hemodialysis are at high risk of bone fractures, and poor nutritional status is considered an important contributing factor. In this population, nutritional disorders are often characterized as protein-energy wasting. The Nutritional Risk Index for Japanese Hemodialysis Patients (NRI-JH) was developed as a marker of protein-energy wasting; however, its relationship with fracture risk remains unclear. In this study, we examined the association between NRI-JH and bone fractures in more than 3,000 Japanese patients receiving hemodialysis. Higher NRI-JH values were independently associated with an increased risk of fractures. These findings suggest that the NRI-JH may help identify hemodialysis patients who are vulnerable to fractures and may benefit from closer nutritional management.", "abstract_shown": true, "affiliations": [ "Department of Nephrology, NHO Fukuokahigashi Medical Center, Fukuoka, Japan", "Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan", "Fukuoka Renal Clinic, Fukuoka, Japan", "Department of Nephrology, Nara Medical University, Nara, Japan", "Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan" ], "article_type": "research article", "arxiv": null, "author_total": 6, "authors": [ { "affs": [ 0 ], "name": "Hokuto Arase" }, { "affs": [ 1 ], "name": "Shunsuke Yamada" }, { "affs": [ 2 ], "name": "Masatomo Taniguchi" }, { "affs": [ 3 ], "name": "Kazuhiko Tsuruya" }, { "affs": [ 4 ], "name": "Tetsuro Ago" }, { "affs": [ 1 ], "name": "Toshiaki Nakano" } ], "bibtex": "https://research.draconitic.com/paper/fpqas94es252v.bib", "cited_by": 0, "doi": "10.1016/j.xkme.2026.101509", "fulltext_url": "http://www.sciencedirect.com/science/article/pii/S2590059526002712", "id": "fpqas94es252v", "issns": [ "2590-0595" ], "landing_url": "https://doi.org/10.1016/j.xkme.2026.101509", "language": "en", "licence": "CC-BY-NC-ND", "licence_label": "CC BY-NC-ND", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Original Research" ], [ "lcc", "RC870-923" ], [ "openalex", "2727|Dialysis and Renal Disease Management" ] ], "openalex": "W7203710815", "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13718858/pdf/?tool=EBI", "pmcid": "PMC13718858", "pmid": "42959993", "published": "2026-08-18", "publisher": "Elsevier", "ris": "https://research.draconitic.com/paper/fpqas94es252v.ris", "sources": [ { "first_seen": "2026-10-30T13:44:37Z", "native_id": "e7e18aba679547e49ee089dd1219b929", "source": "doaj", "url": "https://doi.org/10.1016/j.xkme.2026.101509" }, { "first_seen": "2026-10-31T00:20:39Z", "native_id": "PMC:PMC13718858", "source": "europepmc", "url": "https://europepmc.org/article/PMC/PMC13718858" }, { "first_seen": "2026-11-01T00:20:52Z", "native_id": "MED:42959993", "source": "europepmc", "url": "https://europepmc.org/article/MED/42959993" }, { "first_seen": "2026-11-02T12:22:48Z", "native_id": "PMC13718858", "source": "pmc", "url": "https://doi.org/10.1016/j.xkme.2026.101509" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2727|Dialysis and Renal Disease Management", "subfield": "general" } ], "title": "Associations Between the Nutritional Risk Index for Japanese Hemodialysis Patients and the Risk of Bone Fractures in Patients Receiving Hemodialysis: The Q-Cohort Study", "title_text": "Associations Between the Nutritional Risk Index for Japanese Hemodialysis Patients and the Risk of Bone Fractures in Patients Receiving Hemodialysis: The Q-Cohort Study", "type": "peer-reviewed", "updated_at": "2026-11-02T12:22:48Z", "url": "https://research.draconitic.com/paper/fpqas94es252v", "venue": "Kidney Medicine", "versions": [] }