Baseline variables such as demographic features (age and sex), medical history (diabetes mellitus [DM], hypertension, hyperuricemia, and cardiovascular disease [CVD]), clinical parameters (body mass index [BMI] and mean arterial blood pressure [MAP]), and laboratory data (serum creatinine, hemoglobin, albumin, alanine aminotransferase [ALT], white blood cell [WBC], C-reactive protein [CRP], phosphorus, calcium, bicarbonate, uric acid, total cholesterol, triglyceride, glycosylated hemoglobin [HbA1c], and urine protein to creatinine ratio [UPCR]) were collected. The demographic features, medical history and clinical parameters were obtained from medical records and interviews with patients at enrollment. The medical history was obtained by chart review by 2–3 nephrologists. DM and hypertension were defined by clinical diagnosis. Hyperuricemia was defined as uric acid > 7.2 mg/dL in men, > 6.5 mg/dL in women, or under urate-lowering therapy. CVD was defined as clinical diagnosis of ischemic heart disease, congestive heart disease, and cerebrovascular disease. The definition of metabolic syndrome was the presence of three or more of the following five criteria proposed by the Health Promotion Administration, Ministry of Health and Welfare of Taiwan at 2007 (1) fasting blood glucose ≥ 100 mg/dL or diabetes mellitus; (2) systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 85 mmHg or hypertension; (3) HDL cholesterol > 40 mg/dL in men or > 50 mg/dL in women; (4) triglycerides ≥ 150 mg/dL; and (5) waist circumference ≥ 90 cm in men or ≥ 80 cm in women25.

The MAP was calculated by using the formula one-third averaged systolic blood pressure plus two-thirds averaged diastolic blood pressure measured 3 months before and after the enrollment. BMI was calculated as the baseline enrolled measurement by using the formula weight in kilograms divided by height in meters squared. High sensitivity CRP was measured in serum using near the near-infrared particle immunoassay rate method by Beckman Coulter UniCel-DxC 800 (Beckman Coulter); ferritin was measured in serum using two-site immunoenzymatic assay by Beckman Coulter UniCel-DxI 800 (Beckman Coulter); while iron was measured in serum using Fe reagent via timed-endpoint method by Beckman Coulter UniCel-DxC 800 (Beckman Coulter). Transferrin was measured in serum using transferrin reagent via the turbidimetric method by Beckman Coulter UniCel-DxC 800 (Beckman Coulter). And the TIBC value was gained by multiplying transferrin (mg/dL) by a coefficient of 1.4. Laboratory data were averaged and analyzed three months before and after enrollment of the CKD care system.

Malnutrition-inflammation score (MIS) was first proposed by Professor Kalantar-Zadeh for dialysis patients26. MIS, modified for CKD patients, has 10 components including body weight change, dietary intake, gastrointestinal symptoms, functional capacity, comorbidity, fat stores, muscle wasting, BMI, albumin, and total iron-binding capacity. Each score component is classified according to 4 levels of severity, from 0 (normal) to 3 (severely abnormal). Measurements were based on Subjective Global Assessment. Malnutrition-inflammation was defined by MIS > 4, based on ROC curve for outcome prediction27.

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