Prevalence of Malnutrition Inflammation Complex Syndrome among Patients on Maintenance Haemodialysis at Muhimbili National Hospital in Tanzania: A Cross-Sectional Study

Prevalence of Malnutrition Inflammation Complex Syndrome among Patients on Maintenance Haemodialysis at Muhimbili National Hospital in Tanzania: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Prevalence of Malnutrition Inflammation Complex Syndrome among Patients on Maintenance Haemodialysis at Muhimbili National Hospital in Tanzania: A Cross-Sectional Study Puneet Kishore Bramania, Paschal Ruggajo, Rimal Bramania, Muhiddin Mahmoud, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-29225/v3 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Nov, 2020 Read the published version in BMC Nephrology → Version 3 posted 4 You are reading this latest preprint version Show more versions Abstract Background: Malnutrition, inflammation, and the combination thereof are predictors of poor outcomes in haemodialysis patients. Malnutrition Inflammation Complex Syndrome (MICS) is an accelerator of atherosclerosis and portends high mortality. Early recognition and treatment of MICS may help to improve the clinical outlook of such patients. This study investigated the prevalence of MICS and its associated factors among patients on maintenance haemodialysis at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Methods: This was a prospective cross-sectional observational study done among 160 adult patients on maintenance haemodialysis at MNH in 2019. All participants provided written informed consent. Questionnaires were used to collect data and patients’ blood was tested for complete blood count (CBC), C-reactive protein (CRP), ferritin, transferrin, creatinine, urea, total cholesterol, and albumin. The Malnutrition Inflammation Score was used to assess MICS and its severity. Data analysis was done using the SPSS 20 software. Results: Of the 160 patients included in the study, 111 (69.4%) were male. The mean age (±SD) of patients and mean duration (±SD) on haemodialysis were 52.2(13.3) years and 22(18) months respectively. MICS was prevalent in 46.3% (mild in 24.4% and moderate to severe in 21.9%). Long-term haemodialysis (>4years) was an independent predictor of MICS [Adjusted Odds Ratio, AOR 5.04 (95% CI: 1.33–19.2), p<0.05]. Hypercholesterolaemia was a negative predictor of MICS [AOR 0.11 (95% CI: 0.01-0.97), p<0.05]. Patients with MICS had significantly lower mean body mass index, serum albumin, total cholesterol, transferrin, haemoglobin, and creatinine levels. The presence of MICS was higher in underweight patients and those who had inflammation. Haemodialysis adequacy did not correlate with MICS. Conclusion: Malnutrition Inflammation Complex Syndrome is relatively common among patients on haemodialysis in Dar es Salaam, Tanzania. Our study has shown a longer duration on haemodialysis to be associated with the occurrence of MICS; on the contrary, having hypercholesterolaemia seems to be protective against MICS consistent with the concept of reverse epidemiology. Patients on haemodialysis should be assessed regularly for malnutrition and inflammation and should receive appropriate and timely treatment to reduce the burden of associated morbidity, and mortality to these patients. Urology & Nephrology Malnutrition Inflammation Complex Syndrome Haemodialysis in Tanzania. Figures Figure 1 Figure 2 Background Chronic kidney disease (CKD) is associated with high morbidity and mortality [1]. The community prevalence of CKD in a study done in Northern Tanzania has been estimated to be 7%. The urban prevalence is higher than in rural (15.2% versus 2.0%) [2]. Haemodialysis (HD) services provision in Tanzania have been continually rising over the past decade from one haemodialysis center to 27 centers in 2018, most of these are in large cities [3]. There were 933 patients receiving HD in the country as of 2018 [3]. Haemodialysis services in Tanzania are largely reimbursed by the National Health Insurance Fund (NHIF), others pay ‘out of pocket’ and for a few patients HD services are covered by other private insurance or companies. Those paying ‘out of pocket’ may not be able to afford HD services and have a higher risk of poor outcomes [4]. This can be attributed to non-adherence to the standard three times per week haemodialysis. A recent multi-center study by Somji et al in Dar es Salaam, Tanzania reported a high proportion of inadequate HD (59.4%), however, it did not find a significant correlation between HD adequacy and the body mass index (BMI). In the same study, 9.8% of the HD patients were underweight [5]. Malnutrition and inflammation are common problems in patients on HD and are associated with adverse outcomes [6-8]. The combination of these two entities termed Malnutrition Inflammation Complex Syndrome (MICS) portends higher mortality among patients on HD [7, 9]. High prevalence rates for MICS have been reported among patients on HD, a study conducted in Brazil among HD patients of African descent reported MICS in 42.4% while Matiko reported a prevalence of 61.2% among HD patients in Kenya [10, 11]. Malnutrition among HD patients is attributed to several factors including limited dietary intake, dialysis-related nutrient loss, oxidative stress, metabolic acidosis, hyper-metabolism, and chronic inflammation-induced protein breakdown [8, 12]. HD adequacy has been found to be correlated with inflammatory markers like CRP [13]. The prevalence of chronic inflammation among patients on HD ranges from 30% to 50%, this is principally attributed to the uremic milieu that induces pro-inflammatory cytokines, which have negative effects on protein synthesis and may accelerate atherosclerosis [8, 14]. The interplay between atherogenic effects from persistent inflammation and malnutrition contributes to the Malnutrition-Inflammation-Atherosclerosis (MIA) syndrome which has high mortality [6, 15, 16]. MICS may serve as a proxy indicator of atherosclerosis in these patients and its recognition may be important in guiding the treatment of underlying cardiovascular disease [17]. Malnutrition in CKD leads to increased morbidity thus its early recognition and treatment have the potential of reducing the cost of health care. Tanzania has a high burden of CKD; however, there is scarce data on the magnitude of malnutrition and inflammation among these patients including those receiving HD therapy. This study aimed to explore the magnitude of MICS among patients on maintenance haemodialysis and its associated factors at MNH in Dar es Salaam, Tanzania. Methods S tudy design, duration, and setting It is a multi-center (two HD centers of MNH) prospective cross-sectional observational study. The study was conducted between September and November 2019 among patients undergoing haemodialysis at the two HD centers of Muhimbili National Hospital (Upanga and Mloganzila) in Dar es Salaam, Tanzania. Study population All adult patients receiving maintenance HD therapy at the two dialysis units of MNH for at least three months were eligible. Patients who were mentally incapacitated, very sick, bedridden patients, patients with altered levels of consciousness, and those in respiratory distress were excluded. Sample size calculation The sample size for this study was estimated based on the prevalence of MICS of 61.2% reported by Matiko among HD patients in Kenya, using the following formula below [18]. n = n o x N where, n o = Z 2 p (1-p) n o + (N-1) e 2 Whereby: n = Minimum sample size needed n o = Is the sample size without considering the finite population correction factor N= The total number of haemodialysis patients at both renal centers of MNH (At the time of preparation of the study protocol there were 284 patients on HD) Z = Standard normal deviation = 1.96 (at 95% Confidence Interval) p = Prevalence of MICS. p=61.2%=0.612 among HD patients in a study done in Kenya [11]. e = Margin of error which was set at 5%=0.05 Substituting these figures in the formula gives; n = 160 Therefore, the minimum required sample size was 160 patients. Sampling method Simple random sampling was utilized to select participants for this study. A list of all patients on HD therapy was obtained from the HD units record books at the beginning of the study. Patients were assigned numbers then the Stat Trek's Random Number Generator was used to select participants recruited in this study [19]. Data collection methods Data were actively collected by an ad hoc questionnaire (Supplementary S1) which included participant’s demographic and clinical data, questions about dietary intake, gastrointestinal symptoms; functional capacity, and co-morbid status. These were taken from the Malnutrition Inflammation Score (MIS) [7]. The Malnutrition Inflammation Score is a comprehensive assessment of the nutritional and inflammation status of patients. It has 10 components (5 from medical history, 3 from physical examination, and 2 from laboratory parameters: albumin and transferrin) each has a severity ranging from 0 (normal) to 3 (severely abnormal). The total of all 10 components ranges from 0 (normal) to 30 (severely malnourished); higher scores imply a more severe degree of malnutrition and inflammation. The MIS components include (i) Change in end dialysis dry weight over past 3 months (ii) Dietary intake (iii) Gastrointestinal symptoms (iv) Functional capacity (v) Co-morbidity including the number of years on dialysis (vi) Loss of fat stores (vii) Signs of muscle wasting (viii) Body mass index (BMI) (ix) Serum albumin and (x) Serum Total Iron binding capacity (TIBC) or serum transferrin. Dietary intake was scored 0 for the usual intake of solid foods, with no recent decrease in the amount/quality of meals. A slightly suboptimal solid diet was scored 1, a full-liquid diet or moderate decrease in dietary intake was scored 2 and a score of 3 indicated a hypocaloric liquid diet or starvation. The full description and grading of the severity of these components is available in the study by Kalantar-Zadeh et al, who is the inventor of this scoring system [7]. Body (or somatic) mass was assessed using the body mass index (BMI) that was determined using participants’ post-dialysis dry weight and height. BMI was computed using the weight (kg) and height (m) and was expressed in kg/m 2 : BMI = Weight (kg) ÷ [Height (m)] 2 Body weight was measured using a standard weighing scale while the patient had not worn shoes and a stadiometer was used to measure the height of participants to the nearest centimeter. For patients who were unable to stand in an upright position on the stadiometer, the length from top of the head to the plantar surface of the foot while lying supine was taken in lieu of their height. Patients’ dry weight in the preceding three months was obtained from their HD records and were compared with current post-dialysis dry weight to calculate the percentage change. The loss of subcutaneous fat was assessed below the eyes, triceps, biceps, and chest. Signs of muscle wasting were assessed at the temple, clavicle, scapula, ribs, quadriceps, knee, and interosseous regions. Subcutaneous fat loss, muscle wasting, and BMI were categorized based on the MIS [7]. Laboratory tests Blood specimen (10 mls) was obtained from each participant before and after dialysis and was sent to the Central Pathology Laboratory at MNH. Laboratory testing was performed to determine complete blood count (CBC), C-reactive protein (CRP), ferritin, transferrin, creatinine, urea, total cholesterol, and albumin. Post-dialysis creatinine and urea were also determined. CELL DYN 3700 and ARCHITECT PLUS machines were used to analyze complete blood count and serum biochemistry respectively. CRP was analyzed at the Muhimbili University of Health and Allied Sciences (MUHAS) Clinical Research Laboratory using the COBAS INTEGRA 400, which uses Finecare CRP Rapid Quantitative test that is based on the fluorescence immunoassay. Data management and analysis Questionnaires were checked for completeness after which data were entered into the Statistical Package for Social Sciences (SPSS) version 20 for data cleaning and analysis. Data were summarized into frequency distribution and two-way tables. Association between categorical variables was determined using the Chi-square and Fischer’s exact tests while continuous variables association was determined using student t-test and analysis of variance (ANOVA). Non-parametric variables were compared using Mann-Whitney U-test. Binary Logistic regression analysis (univariate and multivariate) was performed to determine the predictors/factors associated with MICS. A two-tailed p-value of less than 0.05 was regarded as statistically significant and the Hosmer-Lemeshow test was used to assess goodness of fit for the final logistic regression model. Study variables The main outcome variable was the presence of MICS as defined by an aggregate MIS of 6 or more. The severity of MICS was graded as: A MIS of less than 6 was categorized as Normal , between 6 and 10 as Mild and a score of 11 or more was considered as Moderate to Severe [11]. Body size (BMI) categories for this study were defined as Underweight (BMI 25 kg/m 2 ) [20]. A pre-dialysis CRP level above 5 mg/l was defined as having Inflammation [21]. Anemia was defined by a haemoglobin level below 13 g/dl in males and below 12 g/dl for females based on KDIGO guidelines [22]. Hypercholesterolaemia was defined by a serum total cholesterol (TC) level above 220 mg/dl (the upper limit of the normal range at MNH Laboratory). Adequate dialysis was defined as having Urea Reduction Ratio (URR) of 65% or more (calculated as URR = (Pre-dialysis Urea - Post-dialysis Urea)/Pre-dialysis Urea X 100%) [23]. Results Among the 294 patients on HD therapy in both centers at the beginning of the data collection, 160 participants were studied/analyzed. (Figure 1) Baseline Socio-demographic-clinical characteristics of participants As planned, 160 patients were included in the evaluation. 17.1% of the males and 32.7% of the females resulted in moderate/severe MICS status. The mean age (±SD) of patients was 52.2(13.3) years and the mean duration on HD therapy was 22 ( + 18) months (range: 3 to 126 months). Most of them, 132 (82.5%) were receiving three times per week HD therapy and 76 (47.5%) had an arteriovenous fistula (AVF) as the vascular access in use for HD. The majority of them, 136 (85%) were living with a partner, and 144 (90%) were covered by health insurance. Comorbidity-wise, almost all 154 (96.3%) had hypertension that was as well the commonest (43.1%) reported cause of End-Stage Renal Disease (ESRD). Diabetes mellitus was prevalent in 43.1% and anemia was present in 153 (95.6 %) patients. (Table 1) Table 1 . Socio-demographic and clinical characteristics of patients in relation to severity of MICS (N=160) Characteristics n (%) MICS status p-value No Mild Mod-Severe Age groups (years) 18-39 40 – 59 > 60 30 (18.8%) 75 (46.9%) 55 (34.4%) 12 (40.0%) 46 (61.3%) 28 (50.9%) 9 (30.0%) 17 (22.7%) 13 (23.6%) 9 (30.0%) 12 (16.0%) 14 (25.5%) 0.310 a Mean Age ( + SD) years 52.2 + 13.3 53.2 + 11.8 49.7 + 14.4 52.6 + 15.3 0.397 c Gender Male Female 111 (69.4%) 49 (30.6%) 65 (58.6%) 21 (42.9%) 27 (24.3%) 12 (24.5%) 19 (17.1%) 16 (32.7%) 0.072 a Marital Status Living with a partner Single 136 (85.0%) 24 (15.0%) 74 (54.4%) 12 (50.0%) 32 (23.5%) 7 (29.2%) 30 (22.1%) 5 (20.8%) 0.837 a Level of Education No Formal / Primary Post-primary 41 (25.6%) 119 (74.4%) 19 (46.3%) 67 (56.3%) 13 (31.7%) 26 (21.8%) 9 (22.0%) 26 (21.8%) 0.429 a Mode of Payment Health Insurance Out Of Pocket 144 (90.0%) 16 (10.0%) 78 (54.2%) 8 (50.0%) 34 (23.6%) 5 (31.2%) 32 (22.2%) 3 (18.8%) 0.776 b Frequency of HD Thrice/week Twice/week 132 (82.5%) 28 (17.5%) 73 (55.3%) 13 (46.4%) 30 (22.7%) 9 (32.1%) 29 (22.0%) 6 (21.4%) 0.575 a Duration of HD (years) 4 54 (33.8%) 92 (57.4%) 14 (8.8%) 34 (63.0%) 49 (53.3%) 3 (21.4%) 16 (29.6%) 22 (23.9%) 1 (7.1%) 4 (7.4%) 21 (22.8%) 10 (71.4%) <0.001 b Duration on HD (months) Mean ( + SD) 22 + 18 17.9 + 12.3 18 + 13.5 34.7 + 26.3 <0.001 c Vascular Access AV Fistula Central Venous Catheter 76 (47.5%) 84 (52.5%) 42 (55.3%) 44 (52.4%) 16 (21.1%) 23 (27.4%) 18 (23.7%) 17 (20.2%) 0.644 a Dialysis Adequacy Inadequate (URR 65%) 38 (23.8%) 122 (76.3%) 19 (50.0%) 67 (54.9%) 8 (21.1%) 31 (25.4%) 11 (28.9%) 24 (19.7%) 0.479 a Diabetes Mellitus Yes No 69 (43.1%) 91 (56.9%) 40 (58.0%) 46 (50.5%) 12 (17.4%) 27 (29.7%) 17 (24.6%) 18 (19.8%) 0.198 a Hypertension Yes No 154 (96.3%) 6 (3.7%) 83 (53.9%) 3 (50.0%) 37 (24.0%) 2 (33.3%) 34 (22.1%) 1 (16.7%) 0.863 b Hypercholesterolaemia Yes (TC > 220mg/dl) No (TC < 220mg/dl) 9 (5.6%) 151 (94.4%) 8 (88.9%) 78 (51.7%) 1 (11.1%) 38 (25.2%) 0 (0.0%) 35 (23.2%) 0.133 b HIV Infection Yes No 15 (9.4%) 145 (90.6%) 5 (33.3%) 81 (55.9%) 5 (33.3%) 34 (23.4%) 5 (33.3%) 30 (20.7%) 0.223 b HBV Infection Yes No 9 (5.6%) 151 (94.4%) 5 (55.6%) 81 (53.6%) 3 (33.3%) 36 (23.8%) 1 (11.1%) 34 (22.5%) 0.740 b a Chi-square test, b Fisher’s exact test, c ANOVA Prevalence and Severity of Malnutrition Inflammation Complex Syndrome (MICS) Of the 160 patients on maintenance haemodialysis, 74 (46.3%) had MICS and these were categorized as mild MICS in 39 (24.4%) and moderate to severe MICS in 35 (21.9%) of the patients. (Figure 2) Malnutrition Inflammation Score and its parameters The Malnutrition-Inflammation-Score (MIS) ranged from 0 to 28 with a median MIS of 5 and a mean (±SD) MIS of 7.6 (±5.1). Compared to well-nourished patients, the mean MIS was significantly higher among underweight patients (14.8 vs 6.2, p0.5kg over the preceding 3 months was present in 104 (65%) patients and severe dry weight loss (>5%) was present in only 13 (8.1%) patients. Dietary intake was good in almost half; 87 (54.4%) patients, and severe dietary limitations were present in only four (2.5%) patients. About one-third of the patients, 50 (31.2%) had some gastrointestinal symptoms. Physical examination revealed 98 (61.3%) patients had normal fat stores and 83 (51.9%) patients had no muscle wasting. Severe muscle wasting was present in 14 (8.8%) patients. Body size, Inflammation and its association with MICS Among the 160 patients, 27 (16.9%) were underweight and among the 103 patients whose CRP was measured, 84 (81.6%) had inflammation (CRP>5 mg/l). The presence of MICS was higher in underweight patients. Also, inflammation was significantly associated with MICS. (Table 2) Table 2. Association between Body size and Inflammation with MICS Body size (N=160) MICS Present MICS Absent TOTAL p-value Underweight 26 (96.3%) 1 (3.7%) 27 (100%) <0.001 * Normal weight 46 (48.4%) 49 (51.6%) 95 (100%) Over-weight/Obese 2 (5.3%) 36 (94.7%) 38 (100%) Inflammation (N=103) Present 53 (63.1%) 31 (36.9%) 84 (100%) <0.001 * Absent 2 (10.5%) 17 (89.5%) 19 (100%) * Test Statistic: Fisher’s exact test Factors associated with Malnutrition Inflammation Complex Syndrome In univariate analysis female gender, longer duration on HD, hypercholesterolaemia, and having HIV associated with the occurrence of MICS. For multivariate analysis, the purposive selection of variables showing a univariate p<0.2 were included in the final regression logistic model. Patients with high cholesterol levels seemed to be protected against the development of MICS. Finally, patients longer on haemodialysis significantly associated with a higher risk for MICS. (Table 3) Table 3 . Factors associated with Malnutrition Inflammation Complex Syndrome (N=160) Characteristics COR a (95% CI) p-value AOR b (95% CI) p-value Age groups 60 years Ref 1.19 (0.62-2.3) 0.60 - - Gender Male Female Ref 1.88 (0.95-3.72) 0.07 Ref 2.03 (0.97-4.25) 0.061 Marital Status Living with a partner Single Ref 1.19 (0.5-2.84) 0.69 - - Mode of payment Health Insurance Paying out of pocket Ref 1.18 (0.42-3.32) 0.75 - - Duration on HD 4 years Ref 4.83 (1.29-18) 0.02 Ref 5.04 (1.33-19.2) 0.018 Frequency of HD Thrice/week Twice/week Ref 1.43 (0.63-3.24) 0.39 - - Vascular Access AV Fistula Central Venous Catheter Ref 1.12 (0.6-2.09) 0.72 - - Dialysis Adequacy Inadequate (URR 65%) 1.22 (0.59-2.53) Ref 0.60 - - Diabetes Mellitus Yes No 0.74 (0.4-1.4) Ref 0.35 - - Hypertension Yes No 0.86 (0.17-4.37) Ref 0.85 - - Hypercholesterolaemia Yes (TC > 220mg/dl) No (TC < 220mg/dl) 0.13 (0.02-1.1) Ref 0.06 0.11 (0.01-0.97) Ref 0.047 HIV Infection Yes No 2.53 (0.82-7.78) Ref 0.11 2.55 (0.78-8.4) Ref 0.123 HBV Infection Yes No 0.93 (0.24-3.58) Ref 0.91 - - Hosmer Lemeshow Test for Multivariate Logistic regression, p=0.656 → Goodness of fit present a Crude Odds Ratio (COR) b Adjusted Odds Ratio (AOR) Association between MICS and nutritional, inflammatory, and other laboratory parameters Patients with MICS had significantly lower mean dry-weight, BMI, haemoglobin, albumin, total cholesterol, transferrin, and creatinine levels. The median CRP level was significantly higher in patients with MICS. (Table 4) Table 4. Association between MICS and nutritional, inflammatory and other laboratory parameters Parameters N MICS Present (Mean + SD) MICS Absent (Mean + SD) p-value Nutritional parameters Dry weight (kg) 160 56.6 + 9.4 68.9 + 10.9 <0.01 a BMI (kg/m 2 ) 160 20.2 + 2.7 24.4 + 3.8 <0.01 a Albumin (g/dl) 160 3.47 + 0.49 3.94 + 0.36 <0.01 a Total Cholesterol (mg/dl) 160 138.7 + 34.4 163.3 + 40.6 <0.01 a Inflammatory markers Transferrin (mg/dl) 160 164.1 + 40.2 217.8 + 44.4 <0.01 a CRP (mg/l) 103 22.5 (IQR=12.7-43.3) 10.45 (IQR=5.0-16.8) <0.01 b Ferritin (ng/ml) 102 138.2 (IQR=75-349.8) 100.2 (IQR=49.5-216.7) NS b Other laboratory parameters WBC (x 10 9 /L) 160 5.21 + 2.78 4.93 + 1.79 NS a Haemoglobin (g/dl) 160 8.8 + 2.0 9.7 + 1.8 <0.01 a Pre-dialysis Cr (µmol/l) 160 768 + 316 911 + 412 0.016 a Post-dialysis Cr (µmol/l) 160 267 + 128 361 + 202 0.05), IQR-Interquartile Range In this cross-sectional study, 160 haemodialysis patients were recruited to determine the prevalence of Malnutrition Inflammation Complex Syndrome and its associated factors at MNH in Dar es Salaam, Tanzania. More than two-thirds of the patients, 111 (69.4%) were male and the majority 132 (82.5%) were on HD three times per week (as per KDOQI recommendations). The prevalence of MICS was 46.3% and based on severity; MICS was categorized as mild in 24.4% and moderate to severe in 21.9% of the patients. In multivariate analysis, longer duration on HD (>4years) was a significant predictor of MICS and hypercholesterolaemia was a negative predictor of MICS. Patients with MICS had significantly lower mean BMI, albumin, total cholesterol, transferrin, haemoglobin, and creatinine levels. The prevalence of MICS found in this study may not reliably reflect the situation in Tanzania due to rural-urban disparities in access to dialysis services [3]. A lower prevalence of MICS was noted in this study as compared to 61.2% reported by Matiko in a study conducted among HD patients in Kenya [11]. This difference could be attributed to the adequacy of dialysis as indicated by lower frequency (two times weekly) of dialysis in the study by Matiko as compared to our study in which most patients were getting three times per week dialysis. [11]. Inadequate dialysis can lead to persistently high urea levels, subsequent inflammation, and protein catabolism [12]. However, in this study, HD adequacy as assessed by URR did not associate with MICS. In this study, moderate to severe MICS was noted in 21.9% of HD patients, this is similar to a study from South Africa that reported it to be 22% [24]. The prevalence of underweight HD patients was 16.9%; this was higher than the prevalence of 9.8% reported by Somji et al in a study conducted in Dar es Salaam, Tanzania among HD patients [5]. The prevalence of underweight HD patients found in our study was lower when compared to other studies in African countries; 20.9% in Kenya [11], 29.2% in Niger [25], and 28.3% in Cameroon [26]. Patients with MICS have varying degrees of muscle wasting [12, 17]. In this study, patients with MICS had a mean BMI of 20.2 + 2.7 kg/m 2 and almost half (48.4%) of the patients with normal BMI had MICS, this implies that BMI alone is not accurate for nutritional assessment in HD patients. The Malnutrition Inflammation Score is a better tool in the assessment of the nutritional status of HD patients and has been found to better correlate with morbidity, quality of life, and mortality [7, 9, 10]. Several factors affect the nutritional status of HD patients; decreased calorie intake, inadequate dialysis, metabolic acidosis, persistent inflammation, and HD-related catabolism [8, 12]. In this study, almost half of the patients had reported some deterioration in dietary intake and almost a third of patients reported gastrointestinal symptoms that may limit adequate dietary intake. In our study, inflammation was present in 81.6% of the patients; this was lower than that found in the Kenyan study where all patients had raised CRP [11]. Inflammation in HD patients is common and largely attributed to persistent uremia. There are multiple other triggers including HD procedure itself, dialysate quality, and bio-incompatibility of dialysis membranes [4, 9]. The median CRP in our study was significantly higher in patients with MICS, this is consistent with a study done in Mexico [27]. In this study, patients on HD for a longer duration (>4 years) had 5 times the odds of having MICS compared to those on HD for less than 4 years. This finding is consistent with findings from a study by Omari et al who reported a long duration of dialysis to be linked with malnutrition inflammatory syndrome in Palestine [28]. The longer duration on HD therapy results in prolonged exposure of patients to negative effects of HD including dialysis-related inflammation, loss of nutrients, and increased energy expenditure that subsequently can result in malnutrition [12]. This highlights the need for efforts to increase uptake of HD patients into the kidney transplantation program to limit the time spent on chronic HD therapy. Low socioeconomic status and limited access to health insurance significantly influence the adequacy of haemodialysis [4]. We found that the small group of patients who were paying ‘out of pocket’ (ie. not insured) had slightly higher odds of having MICS. There was a significant difference in the frequency of HD among these two groups; 87.5% of those paying ‘out of pocket’ versus 9.7% of those who had health insurance were having twice per week HD (p<0.05). Thus health insurance offers the best option for sustaining the adherence to standard long-term haemodialysis. Aging has been reported to correlate with MICS but did not show this effect in our study. This might be attributed to the younger age of patients in this study compared to that reported by Rambod et al in a study among HD patients in California who found a higher burden of MICS among older patients on HD [9]. Similarly, other studies on MICS done in Kenya, Brazil, and Mexico also had a younger population; mean age <50years [10, 11, 27]. Some of the possible reasons could be due to variations in the profile of the HD patients which can be affected by differences in survival, recruitment in renal transplantation, and the access to sustainable maintenance HD services. MICS among older patients is attributed largely to co-morbidities including depression that may also affect the dietary intake of these patients. In this study, the mean total cholesterol level was significantly lower in patients with MICS, which is contrary to a report by Valencia et al that reported no difference in cholesterol levels between dialysis patients with and without MICS in Mexico [27]. Cholesterol is an important nutritional biomarker among patients on HD therapy and hypercholesterolaemia may be protective in these patients unlike the general population [29, 30]. Serum albumin was noted to be significantly lower among patients with MICS; this was an expected finding consistent with reports from other similar studies [9, 10]. Albumin is a good indicator of protein-energy malnutrition in CKD. Hypoalbuminaemia is attributed to visceral protein loss among patients undergoing HD as well as peritoneal dialysis [12]. Serum creatinine levels have also been reported to be lower among patients with MICS. [10, 27]. The phenomenon of hypocholesterolaemia and hypocreatininaemia among patients on chronic dialysis, accompanied by MICS is referred to as ‘ reverse epidemiology ’. Reverse epidemiology is paradoxically associated with poor cardiovascular outcomes [29, 30], therefore health care providers providing chronic dialysis therapy should be vigilant and monitor these markers regularly to improve outcomes of chronic dialysis. Strengths and Limitations This is the first study in Tanzania to explore the burden of malnutrition and inflammation in HD patients. The other strength of this study was that it also assessed the relationship between nutritional and inflammatory biomarkers with MICS and was shown to be correlated hence reinforces the need for synergistic assessment of these parameters. In view of the study settings, the data may not be generalized for the whole country. Another limitation of this study was the observer bias while measuring fat and muscle loss. Systematic errors during the measurement of anthropometric indices could have occurred. There might be some selection bias from (i) larger number of health insured patients compared to the small number of patients paying ‘out of pocket’ (ii) exclusion of a small group of very sick and mentally debilitated patients. This may underestimate the outcome. The CRP test was not done for all patients; this was due to financial restrictions and other logistic challenges. Discussion In this cross-sectional study, 160 haemodialysis patients were recruited to determine the prevalence of Malnutrition Inflammation Complex Syndrome and its associated factors at MNH in Dar es Salaam, Tanzania. More than two-thirds of the patients, 111 (69.4%) were male and the majority 132 (82.5%) were on HD three times per week (as per KDOQI recommendations). The prevalence of MICS was 46.3% and based on severity; MICS was categorized as mild in 24.4% and moderate to severe in 21.9% of the patients. In multivariate analysis, longer duration on HD (>4years) was a significant predictor of MICS and hypercholesterolaemia was a negative predictor of MICS. Patients with MICS had significantly lower mean BMI, albumin, total cholesterol, transferrin, haemoglobin, and creatinine levels. The prevalence of MICS found in this study may not reliably reflect the situation in Tanzania due to rural-urban disparities in access to dialysis services [3]. A lower prevalence of MICS was noted in this study as compared to 61.2% reported by Matiko in a study conducted among HD patients in Kenya [11]. This difference could be attributed to the adequacy of dialysis as indicated by lower frequency (two times weekly) of dialysis in the study by Matiko as compared to our study in which most patients were getting three times per week dialysis. [11]. Inadequate dialysis can lead to persistently high urea levels, subsequent inflammation, and protein catabolism [12]. However, in this study, HD adequacy as assessed by URR did not associate with MICS. In this study, moderate to severe MICS was noted in 21.9% of HD patients, this is similar to a study from South Africa that reported it to be 22% [24]. The prevalence of underweight HD patients was 16.9%; this was higher than the prevalence of 9.8% reported by Somji et al in a study conducted in Dar es Salaam, Tanzania among HD patients [5]. The prevalence of underweight HD patients found in our study was lower when compared to other studies in African countries; 20.9% in Kenya [11], 29.2% in Niger [25], and 28.3% in Cameroon [26]. Patients with MICS have varying degrees of muscle wasting [12, 17]. In this study, patients with MICS had a mean BMI of 20.2 + 2.7 kg/m 2 and almost half (48.4%) of the patients with normal BMI had MICS, this implies that BMI alone is not accurate for nutritional assessment in HD patients. The Malnutrition Inflammation Score is a better tool in the assessment of the nutritional status of HD patients and has been found to better correlate with morbidity, quality of life, and mortality [7, 9, 10]. Several factors affect the nutritional status of HD patients; decreased calorie intake, inadequate dialysis, metabolic acidosis, persistent inflammation, and HD-related catabolism [8, 12]. In this study, almost half of the patients had reported some deterioration in dietary intake and almost a third of patients reported gastrointestinal symptoms that may limit adequate dietary intake. In our study, inflammation was present in 81.6% of the patients; this was lower than that found in the Kenyan study where all patients had raised CRP [11]. Inflammation in HD patients is common and largely attributed to persistent uremia. There are multiple other triggers including HD procedure itself, dialysate quality, and bio-incompatibility of dialysis membranes [4, 9]. The median CRP in our study was significantly higher in patients with MICS, this is consistent with a study done in Mexico [27]. In this study, patients on HD for a longer duration (>4 years) had 5 times the odds of having MICS compared to those on HD for less than 4 years. This finding is consistent with findings from a study by Omari et al who reported a long duration of dialysis to be linked with malnutrition inflammatory syndrome in Palestine [28]. The longer duration on HD therapy results in prolonged exposure of patients to negative effects of HD including dialysis-related inflammation, loss of nutrients, and increased energy expenditure that subsequently can result in malnutrition [12]. This highlights the need for efforts to increase uptake of HD patients into the kidney transplantation program to limit the time spent on chronic HD therapy. Low socioeconomic status and limited access to health insurance significantly influence the adequacy of haemodialysis [4]. We found that the small group of patients who were paying ‘out of pocket’ (ie. not insured) had slightly higher odds of having MICS. There was a significant difference in the frequency of HD among these two groups; 87.5% of those paying ‘out of pocket’ versus 9.7% of those who had health insurance were having twice per week HD (p<0.05). Thus health insurance offers the best option for sustaining the adherence to standard long-term haemodialysis. Aging has been reported to correlate with MICS but did not show this effect in our study. This might be attributed to the younger age of patients in this study compared to that reported by Rambod et al in a study among HD patients in California who found a higher burden of MICS among older patients on HD [9]. Similarly, other studies on MICS done in Kenya, Brazil, and Mexico also had a younger population; mean age <50years [10, 11, 27]. Some of the possible reasons could be due to variations in the profile of the HD patients which can be affected by differences in survival, recruitment in renal transplantation, and the access to sustainable maintenance HD services. MICS among older patients is attributed largely to co-morbidities including depression that may also affect the dietary intake of these patients. In this study, the mean total cholesterol level was significantly lower in patients with MICS, which is contrary to a report by Valencia et al that reported no difference in cholesterol levels between dialysis patients with and without MICS in Mexico [27]. Cholesterol is an important nutritional biomarker among patients on HD therapy and hypercholesterolaemia may be protective in these patients unlike the general population [29, 30]. Serum albumin was noted to be significantly lower among patients with MICS; this was an expected finding consistent with reports from other similar studies [9, 10]. Albumin is a good indicator of protein-energy malnutrition in CKD. Hypoalbuminaemia is attributed to visceral protein loss among patients undergoing HD as well as peritoneal dialysis [12]. Serum creatinine levels have also been reported to be lower among patients with MICS. [10, 27]. The phenomenon of hypocholesterolaemia and hypocreatininaemia among patients on chronic dialysis, accompanied by MICS is referred to as ‘ reverse epidemiology ’. Reverse epidemiology is paradoxically associated with poor cardiovascular outcomes [29, 30], therefore health care providers providing chronic dialysis therapy should be vigilant and monitor these markers regularly to improve outcomes of chronic dialysis. Strengths and Limitations This is the first study in Tanzania to explore the burden of malnutrition and inflammation in HD patients. The other strength of this study was that it also assessed the relationship between nutritional and inflammatory biomarkers with MICS and was shown to be correlated hence reinforces the need for synergistic assessment of these parameters. In view of the study settings, the data may not be generalized for the whole country. Another limitation of this study was the observer bias while measuring fat and muscle loss. Systematic errors during the measurement of anthropometric indices could have occurred. There might be some selection bias from (i) larger number of health insured patients compared to the small number of patients paying ‘out of pocket’ (ii) exclusion of a small group of very sick and mentally debilitated patients. This may underestimate the outcome. The CRP test was not done for all patients; this was due to financial restrictions and other logistic challenges. Conclusion Malnutrition Inflammation Complex Syndrome (MICS) is prevalent among haemodialysis patients at MNH with a significantly higher burden among those with a long duration of haemodialysis therapy. Hypercholesterolaemia was noted to be protective against the occurrence of MICS consistent with the concept of reverse epidemiology. Hypoalbuminaemia and hypocholesterolemia in haemodialysis patients should prompt further investigations for their nutritional and inflammation status. We recommend that patients on maintenance haemodialysis should be assessed regularly and treated accordingly for malnutrition and inflammation with more emphasis on patients longer on haemodialysis. We also recommend further studies at our set up to explore the possible causes of the high prevalence of MICS. Abbreviations ANOVA-Analysis of variance AOR-Adjusted Odds Ratio AVF-Arteriovenous fistula BMI-Body Mass Index CI-Confidence Interval CKD-Chronic Kidney Disease COR- Crude Odds Ratio CRP-C-reactive protein ESRD-End Stage Renal Disease HD-Haemodialysis HBV-Hepatitis B Virus HIV-Human Immunodeficiency Virus IQR-Interquartile Range KDOQI-Kidney Disease Outcome Quality Initiative MIA-Malnutrition Inflammation Atherosclerosis syndrome MICS-Malnutrition Inflammation Complex Syndrome MIS-Malnutrition Inflammation Score MNH-Muhimbili National Hospital MUHAS-Muhimbili University of Health and Allied Sciences NHIF-National Health Insurance Fund TC-Total Cholesterol URR-Urea Reduction Ratio WBC-White cell count Declarations Ethics approval and consent to participate MUHAS Ethical committee of Research and Publication approved this study with ethical registration number DA.287/298/01A. Permission to conduct this study at MNH was granted by hospitals’ respective research office. Written informed consent was obtained from all participants before recruitment and enrolled study subjects had the right to withdraw from the study at any point when they felt necessary. Consent for publication Not applicable. Availability of data and materials The dataset generated and/or analyzed during the current study is available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding None. Authors' contributions PKB prepared the study design, analyzed the data, interpreted the findings and was a main contributor in writing the manuscript. PR, RB, MM, and FF participated in the study design and revised the manuscript. All authors read and approved the final manuscript. Acknowledgments The authors would like to express truthful appreciation to the renal unit at Muhimbili National Hospital for their assistance during the data collection. References Tonelli M, Wiebe N, Culleton B, House A, Rabbat C, Fok M, McAlister F, Garg AX. Chronic Kidney Disease and Mortality Risk: A Systematic Review. Journal of the American Society of Nephrology. 2006 Jul; 17(7):2034–47 Stanifer JW, Maro V, Egger J, Karia F, Thielman N, Turner EL, Shimbi D, Kilaweh H, Matemu O, Patel UD. The epidemiology of chronic kidney disease in Northern Tanzania: a population-based survey. PloS one. 2015 April 17; 10(4):e0124506. Furia FF, Shoo J, Ruggajo PJ, Kilonzo K, Basu G, Yeates K, Varughese S, Svarstad E, Kisanga O. Developing nephrology services in low income countries: a case of Tanzania. BMC nephrology. 2019 Dec 1; 20(1):378. Meremo AJ, Ngilangwa DP, Mwashambwa MY, Masalu MB, Kapinga J, Tagalile R, Sabi I. Challenges and outcomes of haemodialysis among patients presenting with kidney diseases in Dodoma, Tanzania. BMC nephrology. 2017 Dec 1;18(1):212. Somji SS, Ruggajo P, Moledina S. Adequacy of Hemodialysis and Its Associated Factors among Patients Undergoing Chronic Hemodialysis in Dar es Salaam, Tanzania. International Journal of Nephrology. 2020; 2020. Stenvinkel P, Heimbu O, Lindholm B, Kaysen GA, Bergstro J. Are there two types of malnutrition in chronic renal failure ? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrology Dialysis Transplantation. 2000 Jul 1; 15:953–60. Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH. A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. American Journal of Kidney Diseases. 2001 Dec 1; 38(6):1251–63. Jankowska M, Cobo G, Lindholm B, Stenvinkel P. Inflammation and Protein-Energy Wasting in the Uremic Milieu. InExpanded Hemodialysis. 2017 (Vol. 191, pp. 58-71). Karger Publishers. Rambod M, Bross R, Zitterkoph J, Benner D, Pithia J, Colman S, Kovesdy CP, Kopple JD, Kalantar-Zadeh K. Association of Malnutrition-Inflammation Score with Quality of Life and Mortality in Maintenance Hemodialysis Patients: a 5-Year Prospective Cohort Study. American Journal of Kidney Diseases. 2009 Feb 1; 53(2):298–309. Lopes MB, Silva LF, Lopes GB, Penalva MA, Matos CM, Robinson BM, Lopes AA. Additional Contribution of the Malnutrition–Inflammation Score to Predict Mortality and Patient-Reported Outcomes as Compared With Its Components in a Cohort of African Descent Hemodialysis Patients. Journal of Renal Nutrition. 2017; 27(1):45–52. Matiko Giabe. Malnutrition Inflammation Complex Syndrome among ambulant End Stage Disease patients on Maintenance Hemodialysis at Kenyatta National Hospital. (Master’s dissertation), 2016. University of Nairobi, Kenya. [Cited 2019 April 4] Available from: https://www.semanticscholar.org/paper/Malnutrition-inflammation-complex-syndrome-among-on-Matiko/7ec60df2ae41683e718edaaed58ea9b96d45d4ef Carrero JJ, Stenvinkel P, Cuppari L, Ikizler TA, Kalantar-Zadeh K, Kaysen G, Mitch WE, Price SR, Wanner C, Wang AY, Ter Wee P. Etiology of the Protein-Energy Wasting Syndrome in Chronic Kidney Disease: A Consensus Statement From the International Society of Renal Nutrition and Metabolism (ISRNM). Journal of Renal Nutrition. 2013 Mar 1; 23(2):77–90. Rashid, H, et al. Comparison of C-reactive Protein Levels with Delivered Dose of Kt/V in Patients with End-stage Renal Disease on Maintenance Hemodialysis. Saudi J Kidney Dis Transpl. 2015;26(4):692–6 Jofré R, Rodriguez-Benitez P, López-Gómez JM, Pérez-Garcia R. Inflammatory syndrome in patients on hemodialysis. Journal of the American Society of Nephrology. 2006 Dec 1; 17(12 suppl 3):S274-80. Stenvinkel P, Heimbürger O, Paultre F, Diczfalusy U, Wang T, Berglund L, Jogestrand T. Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney international. 1999 May 1; 55(5):1899-911. Pecoits‐Filho R, Lindholm B, Stenvinkel P. The malnutrition, inflammation, and atherosclerosis (MIA) syndrome–the heart of the matter. Nephrology Dialysis Transplantation. 2002 Nov; 17(suppl_11):28-31. Kalantar-zadeh K. Recent Advances in Understanding the Malnutrition-Inflammation-Cachexia Syndrome in Chronic Kidney Disease Patients: what is next? InSeminars in dialysis. 2005 Sept; 18(5):365–9. Oxford, UK: Blackwell Science Inc. Berenson ML, Levine DM, Krehbiel TC. Basic Business Statistics: Concepts and Application. Twelfth Edition. ( Online Topic ) Chapter 8.7: Estimation and Sample Size Determination for Finite Populations. [Cited: 2018 Nov 26] Available: https://wps.pearsoned.co.uk/wps/media/objects/10721/10978811/Ch_08/levine-smume6_topic_08-07.pdf Random Number Generator. [Internet, Cited 2 nd September, 2019]. Available from https://stattrek.com/statistics/random-number-generator.aspx World Health Organization (WHO). Global Strategy on Diet, Physical Activity and Health. [Cited: 2020 July 31] Available from https://www. Who.int/dietphysicalactivity/childhood_what/en/ Panichi V et al, Migliori M, De Pietro S, Taccola D, Bianchi AM, Norpoth M, Metelli MR, Giovannini L, Tetta C, Palla R. C Reactive protein in patients with Chronic Renal Diseases, Renal Failure. 2001; 23:3-4, 551-562. KDIGO-- Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Kidney International Supplements (2012) 2, 283-287. National Kidney Foundation–Dialysis Outcomes Quality Initiative. Clinical Practice Guidelines and Clinical Practice Recommendations, 2006 Updates. Hemodialysis Adequacy. [Cited: 2020 July 31] Available from http://kidneyfoundation.cachefly.net/professionals/KDOQI/guideline_upHD_PD_VA/hd_guide4.htm Anu Abraham. The Prevalence of Malnutrition Inflammation Complex Syndrome in maintenance hemodialysis patients at Charlotte Maxeke Johannesburg hospital. (Doctoral dissertation), 2019. University of the Witwatersrand, Johannesburg, South Africa. [Cited 2020 April 6]. Available from https://hdl.handle.net/10539/28148 Moussa HD, Tondi ZM, Kane Y, Sani MA, Abdou I, Touré I, Illa A, Omar AE. Assessing the Nutritional Status of Hemodialysis Patients in Sub-Saharan Africa: Experience of Two Hemodialysis Centers in Niger. Open Journal of Nephrology. 2016 Nov 11; 6(4):161-6. Halle MP, Zebaze PN, Mbofung CM, Kaze F, Mbiatat H, Ashuntantang G, Kengne AP. Nutritional status of patients on maintenance hemodialysis in urban sub-Saharan Africa: evidence from Cameroon. Journal of nephrology. 2014 Oct 1; 27(5):545-53. Valencia VC, Rodríguez OM, Sandoval ME, Bermúdez JA, Castellanos SG, de la Cruz CO, Córdova MA. Prevalence of malnutrition-inflammation complex syndrome and its correlation with thyroid hormones in chronic haemodialysis patients. Nefrología (English Edition). 2018 Jan 1; 38(1):57-63. Omari AM, Omari LS, Dagash HH, Sweileh WM, Natour N, Sa’ed HZ. Assessment of nutritional status in the maintenance of haemodialysis patients: a cross-sectional study from Palestine. BMC nephrology. 2019 Dec 1; 20(1):92. Kalantar-Zadeh K, Block G, Humphreys MH, Kopple JD. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Kidney international. 2003 Mar 1; 63(3):793-808. Nurmohamed SA, Nubé MJ. Reverse epidemiology: Paradoxical observations in haemodialysis patients. Netherlands Journal of Medicine. 2005 Nov 1; 63(10):376–81. Supplementary Files SupplementaryS1.QuestionnaireonMICS.pdf Supplementary S1. Questionnaire on MICS Cite Share Download PDF Status: Published Journal Publication published 30 Nov, 2020 Read the published version in BMC Nephrology → Version 3 posted Submission checks completed at journal 19 Nov, 2020 Editorial decision: Accept 16 Nov, 2020 Editor assigned by journal 12 Nov, 2020 Editor invited by journal 12 Nov, 2020 You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-29225","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":5049124,"identity":"2d3d5ba8-2d8d-46de-8802-77c56574b58b","order_by":0,"name":"Puneet Kishore Bramania","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYPCCAxAqgcEGSDI2HiCsIwGuJQ2kpYEELQwMh5EtxQ7MJXIPPvj4404+/7TDzx48qDlvt7b9MNCWGptoXFosZ+QlG85IeGY543aauUHCsdvJ284kArUcS8ttwKHF4EaOmTRPwmEDhtsJZhIJbLeTzQ4AtTA2HManxfz3H6AW+dvp3yQS/p1LNjv/kKAWM2YGoBaD2zlmEoltB+zMbhCwxbLnjbFkT9ozA8PbOWUSiX3JCWY3gLYk4PGLOXuO4YcfNncM5G6nb5P88c3O3ux8+sMHH2pscDsMXSARrDIBh3KsWuzxKB4Fo2AUjIIRCgAGrGk+7ynF1AAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-3052-189X","institution":"Muhimbili University of Health and Allied Sciences School of Medicine","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Puneet","middleName":"Kishore","lastName":"Bramania","suffix":""},{"id":5049125,"identity":"a8ecb789-3f58-4eb1-a720-851e31e6c7a7","order_by":1,"name":"Paschal Ruggajo","email":"","orcid":"","institution":"Muhimbili University of Health and Allied Sciences School of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Paschal","middleName":"","lastName":"Ruggajo","suffix":""},{"id":5049126,"identity":"8f0597e0-e306-43fa-b307-42394b6b7abd","order_by":2,"name":"Rimal Bramania","email":"","orcid":"","institution":"Muhimbili University of Health and Allied Sciences School of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Rimal","middleName":"","lastName":"Bramania","suffix":""},{"id":5049127,"identity":"1f73aa07-ef7c-4c03-9b1f-befb5ddfd851","order_by":3,"name":"Muhiddin Mahmoud","email":"","orcid":"","institution":"Muhimbili National Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Muhiddin","middleName":"","lastName":"Mahmoud","suffix":""},{"id":5049128,"identity":"0a32e5d7-45e0-4734-9105-b9742a84c7c7","order_by":4,"name":"Francis Fredrick Furia","email":"","orcid":"","institution":"Muhimbili University of Health and Allied Sciences School of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Francis","middleName":"Fredrick","lastName":"Furia","suffix":""}],"badges":[],"createdAt":"2020-05-14 21:41:34","currentVersionCode":3,"declarations":"","doi":"10.21203/rs.3.rs-29225/v3","doiUrl":"https://doi.org/10.21203/rs.3.rs-29225/v3","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12882-020-02171-3","type":"published","date":"2020-11-30T15:01:05+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":3794200,"identity":"4e71d91d-801d-486c-ae79-cdc4aa169446","added_by":"auto","created_at":"2020-11-24 15:06:08","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":37746,"visible":true,"origin":"","legend":"Flow diagram to show recruitment of participants","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-29225/v3/6dcaa70244b687930acabfac.jpg"},{"id":3794201,"identity":"4ffbfae1-29de-4c00-9710-b45acd7f3cc2","added_by":"auto","created_at":"2020-11-24 15:06:08","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":26142,"visible":true,"origin":"","legend":"Pie chart to show prevalence of MICS among patients on maintenance haemodialysis at MNH","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-29225/v3/16b751fc986c33529096c500.jpg"},{"id":13620148,"identity":"734aa364-a62a-4b01-8028-40b975849f45","added_by":"auto","created_at":"2021-09-17 07:04:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":614328,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-29225/v3/2c25078f-0302-4fee-a07b-cd0d61efccf5.pdf"},{"id":3794199,"identity":"7bc84683-586c-4737-b103-12ddc17e256d","added_by":"auto","created_at":"2020-11-24 15:06:08","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":127004,"visible":true,"origin":"","legend":"Supplementary S1. Questionnaire on MICS","description":"","filename":"SupplementaryS1.QuestionnaireonMICS.pdf","url":"https://assets-eu.researchsquare.com/files/rs-29225/v3/c6a0cc4de05e8cbdc686998c.pdf"}],"financialInterests":"","formattedTitle":"Prevalence of Malnutrition Inflammation Complex Syndrome among Patients on Maintenance Haemodialysis at Muhimbili National Hospital in Tanzania: A Cross-Sectional Study","fulltext":[{"header":"Background","content":"\u003cp\u003eChronic kidney disease (CKD) is associated with high morbidity and mortality [1]. The community prevalence of CKD in a study done in Northern Tanzania has been estimated to be 7%. The urban prevalence is higher than in rural (15.2% versus 2.0%) [2]. Haemodialysis (HD) services provision in Tanzania have been continually rising over the past decade from one haemodialysis center to 27 centers in 2018, most of these are in large cities [3]. There were 933 patients receiving HD in the country as of 2018 [3]. Haemodialysis services in Tanzania are largely reimbursed by the National Health Insurance Fund (NHIF), others pay \u0026lsquo;out of pocket\u0026rsquo; and for a few patients HD services are covered by other private insurance or companies. Those paying \u0026lsquo;out of pocket\u0026rsquo; may not be able to afford HD services and have a higher risk of poor outcomes [4]. This can be attributed to non-adherence to the standard three times per week haemodialysis. A recent multi-center study by Somji et al in Dar es Salaam, Tanzania reported a high proportion of inadequate HD (59.4%), however, it did not find a significant correlation between HD adequacy and the body mass index (BMI). In the same study, 9.8% of the HD patients were underweight [5].\u003c/p\u003e\n\u003cp\u003eMalnutrition and inflammation are common problems in patients on HD and are associated with adverse outcomes [6-8]. The combination of these two entities termed Malnutrition Inflammation Complex Syndrome (MICS) portends higher mortality among patients on HD [7, 9]. High prevalence rates for MICS have been reported among patients on HD, a study conducted in Brazil among HD patients of African descent reported MICS in 42.4% while Matiko reported a prevalence of 61.2% among HD patients in Kenya [10, 11].\u003c/p\u003e\n\u003cp\u003eMalnutrition among HD patients is attributed to several factors including limited dietary intake, dialysis-related nutrient loss, oxidative stress, metabolic acidosis, hyper-metabolism, and chronic inflammation-induced protein breakdown [8, 12]. HD adequacy has been found to be correlated with inflammatory markers like CRP [13]. The prevalence of chronic inflammation among patients on HD ranges from 30% to 50%, this is principally attributed to the uremic milieu that induces pro-inflammatory cytokines, which have negative effects on protein synthesis and may accelerate atherosclerosis [8, 14]. The interplay between atherogenic effects from persistent inflammation and malnutrition contributes to the Malnutrition-Inflammation-Atherosclerosis (MIA) syndrome which has high mortality [6, 15, 16]. MICS may serve as a proxy indicator of atherosclerosis in these patients and its recognition may be important in guiding the treatment of underlying cardiovascular disease [17].\u003c/p\u003e\n\u003cp\u003eMalnutrition in CKD leads to increased morbidity thus its early recognition and treatment have the potential of reducing the cost of health care. Tanzania has a high burden of CKD; however, there is scarce data on the magnitude of malnutrition and inflammation among these patients including those receiving HD therapy. This study aimed to explore the magnitude of MICS among patients on maintenance haemodialysis and its associated factors at MNH in Dar es Salaam, Tanzania.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eS\u003c/strong\u003e\u003cstrong\u003etudy design, duration, and setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt is a multi-center (two HD centers of MNH) prospective cross-sectional observational study. The study was conducted between September and November 2019 among patients undergoing haemodialysis at the two HD centers of Muhimbili National Hospital (Upanga and Mloganzila) in Dar es Salaam, Tanzania.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll adult patients receiving maintenance HD therapy at the two dialysis units of MNH for at least three months were eligible. Patients who were mentally incapacitated, very sick, bedridden patients, patients with altered levels of consciousness, and those in respiratory distress were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size\u003c/strong\u003e\u003cstrong\u003e calculation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size for this study was estimated based on the prevalence of MICS of 61.2% reported by Matiko among HD patients in Kenya, using the following formula below [18].\u003c/p\u003e\n\u003cp\u003en = \u0026nbsp;\u003cu\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;n\u003csub\u003eo\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/sub\u003ex\u003csub\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/sub\u003eN\u0026nbsp; \u003c/u\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;where,\u0026nbsp;\u0026nbsp;\u0026nbsp; n\u003csub\u003eo\u003c/sub\u003e = \u003cu\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;Z\u003csup\u003e2\u003c/sup\u003e p (1-p)\u0026nbsp; \u003c/u\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; n\u003csub\u003eo \u003c/sub\u003e+ (N-1)\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eWhereby:\u003c/p\u003e\n\u003cp\u003en = Minimum sample size needed\u003c/p\u003e\n\u003cp\u003en\u003csub\u003eo\u003c/sub\u003e = Is the sample size without considering the finite population correction factor\u003c/p\u003e\n\u003cp\u003eN= The total number of haemodialysis patients at both renal centers of MNH (At the time of preparation of the study protocol there were 284 patients on HD)\u003c/p\u003e\n\u003cp\u003eZ = Standard normal deviation = 1.96 (at 95% Confidence Interval)\u003c/p\u003e\n\u003cp\u003ep = Prevalence of MICS. p=61.2%=0.612 among HD patients in a study done in Kenya [11].\u003c/p\u003e\n\u003cp\u003ee = Margin of error which was set at 5%=0.05\u003c/p\u003e\n\u003cp\u003eSubstituting these figures in the formula gives; n = 160\u003c/p\u003e\n\u003cp\u003eTherefore, the minimum required sample size was 160 patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling method\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSimple random sampling was utilized to select participants for this study. A list of all patients on HD therapy was obtained from the HD units record books at the beginning of the study. Patients were assigned numbers then the Stat Trek's Random Number Generator was used to select participants\u003ca name=\"_Toc25421523\"\u003e\u003c/a\u003e\u003ca name=\"_Toc32081765\"\u003e\u003c/a\u003e recruited in this study [19].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were actively collected by an ad hoc\u0026nbsp;questionnaire (Supplementary S1) which included participant\u0026rsquo;s demographic and clinical data, questions about dietary intake, gastrointestinal symptoms; functional capacity, and co-morbid status. These were taken from the Malnutrition Inflammation Score (MIS) [7]. The Malnutrition Inflammation Score is a comprehensive assessment of the nutritional and inflammation status of patients. It has 10 components (5 from medical history, 3 from physical examination, and 2 from laboratory parameters: albumin and transferrin) each has a severity ranging from 0 (normal) to 3 (severely abnormal). The total of all 10 components ranges from 0 (normal) to 30 (severely malnourished); higher scores imply a more severe degree of malnutrition and inflammation. The MIS components include (i) Change in end dialysis dry weight over past 3 months (ii) Dietary intake (iii) Gastrointestinal symptoms (iv) Functional capacity (v) Co-morbidity including the number of years on dialysis (vi) Loss of fat stores (vii) Signs of muscle wasting (viii) Body mass index (BMI) (ix) Serum albumin and (x) Serum Total Iron binding capacity (TIBC) or serum transferrin. Dietary intake was scored 0 for the usual intake of solid foods, with no recent decrease in the amount/quality of meals. A slightly suboptimal solid diet was scored 1, a full-liquid diet or moderate decrease in dietary intake was scored 2 and a score of 3 indicated a hypocaloric liquid diet or starvation. The full description and grading of the severity of these components is available in the study by Kalantar-Zadeh et al, who is the inventor of this scoring system [7].\u003c/p\u003e\n\u003cp\u003eBody (or somatic) mass was assessed using the body mass index (BMI) that was determined using participants\u0026rsquo; post-dialysis dry weight and height. BMI was computed using the weight (kg) and height (m) and was expressed in kg/m\u003csup\u003e2\u003c/sup\u003e: BMI = Weight (kg) \u0026divide; [Height (m)]\u003csup\u003e 2\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eBody weight was measured using a standard weighing scale while the patient had not worn shoes and a stadiometer was used to measure the height of participants to the nearest centimeter. For patients who were unable to stand in an upright position on the stadiometer, the length from top of the head to the plantar surface of the foot while lying supine was taken in lieu of their height.\u003c/p\u003e\n\u003cp\u003ePatients\u0026rsquo; dry weight in the preceding three months was obtained from their HD records and were compared with current post-dialysis dry weight to calculate the percentage change. The loss of subcutaneous fat was assessed below the eyes, triceps, biceps, and chest. Signs of muscle wasting were assessed at the temple, clavicle, scapula, ribs, quadriceps, knee, and interosseous regions. Subcutaneous fat loss, muscle wasting, and BMI were categorized based on the MIS [7].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLaboratory tests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBlood specimen (10 mls) was obtained from each participant before and after dialysis and was sent to the Central Pathology Laboratory at MNH. Laboratory testing was performed to determine complete blood count (CBC), C-reactive protein (CRP), ferritin, transferrin, creatinine, urea, total cholesterol, and albumin. Post-dialysis creatinine and urea were also determined. CELL DYN 3700 and ARCHITECT PLUS machines were used to analyze complete blood count and serum biochemistry respectively. CRP was analyzed at the Muhimbili University of Health and Allied Sciences (MUHAS) Clinical Research Laboratory using the COBAS INTEGRA 400, which uses Finecare CRP Rapid Quantitative test that is based on the fluorescence immunoassay.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData management and analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuestionnaires were checked for completeness after which data were entered into the Statistical Package for Social Sciences (SPSS) version 20 for data cleaning and analysis. Data were summarized into frequency distribution and two-way tables. Association between categorical variables was determined using the Chi-square and Fischer\u0026rsquo;s exact tests while continuous variables association was determined using student t-test and analysis of variance (ANOVA). Non-parametric variables were compared using Mann-Whitney U-test. Binary Logistic regression analysis (univariate and multivariate) was performed to determine the predictors/factors associated with MICS. A two-tailed p-value of less than 0.05 was regarded as statistically significant and the Hosmer-Lemeshow test was used to assess goodness of fit for the final logistic regression model.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe main outcome variable was the presence of MICS as defined by an aggregate MIS of 6 or more. The severity of MICS was graded as: A MIS of less than 6 was categorized as \u003cem\u003eNormal\u003c/em\u003e, between 6 and 10 as \u003cem\u003eMild \u003c/em\u003eand a score of 11 or more was considered as \u003cem\u003eModerate to Severe \u003c/em\u003e[11]. Body size (BMI) categories for this study were defined as \u003cem\u003eUnderweight\u003c/em\u003e (BMI \u0026lt; 18.5 kg/m\u003csup\u003e2\u003c/sup\u003e), \u003cem\u003eWell-nourished\u003c/em\u003e (BMI 18.5 to 24.99 kg/m\u003csup\u003e2\u003c/sup\u003e) and \u003cem\u003eOverweight or Obese\u003c/em\u003e (BMI \u003cu\u003e\u0026gt;\u003c/u\u003e 25 kg/m\u003csup\u003e2\u003c/sup\u003e) [20]. A pre-dialysis CRP level above 5 mg/l was defined as having \u003cem\u003eInflammation \u003c/em\u003e[21]. Anemia was defined by a haemoglobin level below 13 g/dl in males and below 12 g/dl for females based on KDIGO guidelines [22]. Hypercholesterolaemia was defined by a serum total cholesterol (TC) level above 220 mg/dl (the upper limit of the normal range at MNH Laboratory). \u003cem\u003eAdequate dialysis \u003c/em\u003ewas defined as having Urea Reduction Ratio (URR) of 65% or more (calculated as URR = (Pre-dialysis Urea - Post-dialysis Urea)/Pre-dialysis Urea X 100%) [23].\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAmong the 294 patients on HD therapy in both centers at the beginning of the data collection, 160 participants were studied/analyzed. (Figure 1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBaseline Socio-demographic-clinical characteristics of participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs planned, 160 patients were included in the evaluation. 17.1% of the males and 32.7% of the females resulted in moderate/severe MICS status. The mean age (\u0026plusmn;SD) of patients was 52.2(13.3) years and the mean duration on HD therapy was 22 (\u003cu\u003e+\u003c/u\u003e18) months (range: 3 to 126 months). Most of them, 132 (82.5%) were receiving three times per week HD therapy and 76 (47.5%) had an arteriovenous fistula (AVF) as the vascular access in use for HD. The majority of them, 136 (85%) were living with a partner, and 144 (90%) were covered by health insurance. Comorbidity-wise, almost all 154 (96.3%) had hypertension that was as well the commonest (43.1%) reported cause of End-Stage Renal Disease (ESRD). Diabetes mellitus was prevalent in 43.1% and anemia was present in 153 (95.6 %) patients. (Table 1)\u003c/p\u003e\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eTable 1\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:15px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e. Socio-demographic and clinical characteristics of patients in relation to severity of MICS (N=160)\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"margin-left:-13.75pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 131.65pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;background: rgb(217, 217, 217);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:black;'\u003eCharacteristics\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 70.85pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;background: rgb(217, 217, 217);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:black;'\u003en (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 253.15pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;background: rgb(217, 217, 217);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:black;'\u003eMICS status\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 45.45pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;background: rgb(217, 217, 217);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:black;'\u003ep-value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;background: rgb(217, 217, 217);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:black;'\u003eNo\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;background: rgb(217, 217, 217);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:black;'\u003eMild\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;background: rgb(217, 217, 217);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:black;'\u003eMod-Severe\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;background: #F2F2F2;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Calibri\",sans-serif;color:black;'\u003eAge groups (years)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e18-39\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e40 \u0026ndash; 59\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cu\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026gt;\u003c/span\u003e\u003c/u\u003e\u003cspan style='font-size:13px;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;60\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e30 (18.8%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e75 (46.9%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e55 (34.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e12 (40.0%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e46 (61.3%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e28 (50.9%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e9 (30.0%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e17 (22.7%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e13 (23.6%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e9 (30.0%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e12 (16.0%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e14 (25.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45.45pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e0.310\u003csup\u003ea\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131.65pt;padding: 0in 5.4pt;height: 0.3in;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003eMean Age\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;(\u003cu\u003e+\u003c/u\u003e SD) years\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;padding: 0in 5.4pt;height: 0.3in;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e52.2 \u003cu\u003e+\u003c/u\u003e 13.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;padding: 0in 5.4pt;height: 0.3in;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e53.2 \u003cu\u003e+\u003c/u\u003e 11.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;height: 0.3in;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e49.7 \u003cu\u003e+\u003c/u\u003e 14.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;padding: 0in 5.4pt;height: 0.3in;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e52.6 \u003cu\u003e+\u003c/u\u003e 15.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45.45pt;padding: 0in 5.4pt;height: 0.3in;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e0.397\u003csup\u003ec\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;background: #F2F2F2;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Calibri\",sans-serif;color:black;'\u003eGender\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eMale\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eFemale\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;background: white;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;background:white;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:black;'\u003e111 (69.4%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:black;'\u003e49 (30.6%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e65 (58.6%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e21 (42.9%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e27 (24.3%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e12 (24.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e19 (17.1%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e16 (32.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e0.072\u003csup\u003ea\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;background: #F2F2F2;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Calibri\",sans-serif;color:black;'\u003eMarital Status\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eLiving with a partner\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eSingle\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e136 (85.0%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e24 (15.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e74 (54.4%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e12 (50.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e32 (23.5%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e7 (29.2%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e30 (22.1%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e5 (20.8%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e0.837\u003csup\u003ea\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;background: #F2F2F2;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Calibri\",sans-serif;color:black;'\u003eLevel of Education\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eNo Formal / Primary\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003ePost-primary\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e41 (25.6%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e119 (74.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e19 (46.3%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e67 (56.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e13 (31.7%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e26 (21.8%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e9 (22.0%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e26 (21.8%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e0.429\u003csup\u003ea\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;background: #F2F2F2;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Calibri\",sans-serif;color:black;'\u003eMode of Payment\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eHealth Insurance\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eOut Of Pocket\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e144 (90.0%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e16 (10.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e78 (54.2%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e8 (50.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e34 (23.6%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e5 (31.2%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e32 (22.2%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e3 (18.8%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e0.776\u003csup\u003eb\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;background: #F2F2F2;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Calibri\",sans-serif;color:black;'\u003eFrequency of HD\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eThrice/week\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eTwice/week\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e132 (82.5%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e28 (17.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e73 (55.3%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e13 (46.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e30 (22.7%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e9 (32.1%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e29 (22.0%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e6 (21.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e0.575\u003csup\u003ea\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;background: #F2F2F2;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Calibri\",sans-serif;color:black;'\u003eDuration of HD (years)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026lt; 1\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e1-4\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026gt; 4\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e54 (33.8%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e92 (57.4%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e14 (8.8%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e34 (63.0%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e49 (53.3%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e3 (21.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e16 (29.6%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e22 (23.9%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e1 (7.1%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e4 (7.4%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e21 (22.8%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e10 (71.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026lt;0.001\u003csup\u003eb\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;background: #F2F2F2;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Calibri\",sans-serif;color:black;'\u003eDuration on HD (months)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eMean (\u003cu\u003e+\u003c/u\u003e SD)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e22 \u003cu\u003e+\u003c/u\u003e 18\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e17.9 \u003cu\u003e+\u003c/u\u003e 12.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e18 \u003cu\u003e+\u003c/u\u003e 13.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e34.7 \u003cu\u003e+\u003c/u\u003e 26.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026lt;0.001\u003csup\u003ec\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;background:#F2F2F2;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:black;'\u003eVascular Access\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eAV Fistula\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eCentral Venous Catheter\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e76 (47.5%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e84 (52.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e42 (55.3%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e44 (52.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e16 (21.1%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e23 (27.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e18 (23.7%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e17 (20.2%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e0.644\u003csup\u003ea\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;background:#F2F2F2;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:black;'\u003eDialysis Adequacy\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eInadequate (URR \u0026lt; 65%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eAdequate \u0026nbsp; (URR \u003cu\u003e\u0026gt;\u003c/u\u003e 65%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e38 (23.8%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e122 (76.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e19 (50.0%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e67 (54.9%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e8 (21.1%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e31 (25.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e11 (28.9%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e24 (19.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e0.479\u003csup\u003ea\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;background:#F2F2F2;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:black;'\u003eDiabetes Mellitus\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e69 (43.1%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e91 (56.9%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e40 (58.0%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e46 (50.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e12 (17.4%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e27 (29.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e17 (24.6%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e18 (19.8%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e0.198\u003csup\u003ea\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;background:#F2F2F2;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:black;'\u003eHypertension\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e154 (96.3%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e6 (3.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e83 (53.9%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e3 (50.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e37 (24.0%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e2 (33.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e34 (22.1%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e1 (16.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e0.863\u003csup\u003eb\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;background:#F2F2F2;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:black;'\u003eHypercholesterolaemia\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eYes (TC \u0026gt; 220mg/dl)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eNo \u0026nbsp; (TC \u003cu\u003e\u0026lt;\u003c/u\u003e 220mg/dl)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e9 (5.6%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e151 (94.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e8 (88.9%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e78 (51.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e1 (11.1%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e38 (25.2%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e0 (0.0%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e35 (23.2%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e0.133\u003csup\u003eb\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;background:#F2F2F2;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:black;'\u003eHIV Infection\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e15 (9.4%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e145 (90.6%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e5 (33.3%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e81 (55.9%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e5 (33.3%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e34 (23.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e5 (33.3%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e30 (20.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e0.223\u003csup\u003eb\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;background:#F2F2F2;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:black;'\u003eHBV Infection\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e9 (5.6%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e151 (94.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e5 (55.6%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e81 (53.6%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e3 (33.3%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e36 (23.8%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e1 (11.1%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e34 (22.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45.45pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e0.740\u003csup\u003eb\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003csup\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp; a\u003c/span\u003e\u003c/sup\u003e\u003cspan style='font-size:13px;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp; Chi-square test, \u0026nbsp;\u003csup\u003eb \u0026nbsp;\u0026nbsp;\u003c/sup\u003e Fisher\u0026rsquo;s exact test,\u003csup\u003e\u0026nbsp; c\u003c/sup\u003e\u0026nbsp; \u0026nbsp;ANOVA\u003c/span\u003e\u003c/p\u003e\u003cbr\u003e\u003cp\u003e\u003cstrong\u003ePrevalence and Severity of Malnutrition Inflammation Complex Syndrome (MICS) \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 160 patients on maintenance haemodialysis, 74 (46.3%) had MICS and these were categorized as mild MICS in 39 (24.4%) and moderate to severe MICS in 35 (21.9%) of the patients. (Figure 2)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMalnutrition Inflammation Score and its parameters\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Malnutrition-Inflammation-Score (MIS) ranged from 0 to 28 with a median MIS of 5 and a mean (\u0026plusmn;SD) MIS of 7.6 (\u0026plusmn;5.1). Compared to well-nourished patients, the mean MIS was significantly higher among underweight patients (14.8 vs 6.2, p\u0026lt;0.001). Overall dry weight loss \u0026gt;0.5kg over the preceding 3 months was present in 104 (65%) patients and severe dry weight loss (\u0026gt;5%) was present in only 13 (8.1%) patients. Dietary intake was good in almost half; 87 (54.4%) patients, and severe dietary limitations were present in only four (2.5%) patients. About one-third of the patients, 50 (31.2%) had some gastrointestinal symptoms. Physical examination revealed 98 (61.3%) patients had normal fat stores and 83 (51.9%) patients had no muscle wasting. Severe muscle wasting was present in 14 (8.8%) patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBody size, Inflammation and its association with \u003c/strong\u003e\u003cstrong\u003eMICS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 160 patients, 27 (16.9%) were underweight and among the 103 patients whose CRP was measured, 84 (81.6%) had inflammation (CRP\u0026gt;5 mg/l). The presence of MICS was higher in underweight patients. Also, inflammation was significantly associated with MICS. (Table 2)\u003c/p\u003e\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eTable 2.\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:15px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:15px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eAssociation between Body size and Inflammation with MICS\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167.4pt;border-right: none;border-bottom: none;border-left: none;border-image: initial;border-top: 1pt solid windowtext;background: rgb(217, 217, 217);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eBody size\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Calibri\",sans-serif;color:black;'\u003e(N=160)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border-right: none;border-bottom: none;border-left: none;border-image: initial;border-top: 1pt solid windowtext;background: rgb(217, 217, 217);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Calibri\",sans-serif;color:black;'\u003eMICS Present\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75.35pt;border-right: none;border-bottom: none;border-left: none;border-image: initial;border-top: 1pt solid windowtext;background: rgb(217, 217, 217);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Calibri\",sans-serif;color:black;'\u003eMICS Absent\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69.05pt;border-right: none;border-bottom: none;border-left: none;border-image: initial;border-top: 1pt solid windowtext;background: rgb(217, 217, 217);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Calibri\",sans-serif;color:black;'\u003eTOTAL\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74.7pt;border-right: none;border-bottom: none;border-left: none;border-image: initial;border-top: 1pt solid windowtext;background: rgb(217, 217, 217);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Calibri\",sans-serif;color:black;'\u003ep-value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eUnderweight\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e26 (96.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75.35pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e1 (3.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69.05pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e27 (100%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 74.7pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026lt;0.001\u003c/span\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e*\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eNormal weight\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e46 (48.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75.35pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e49 (51.6%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69.05pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e95 (100%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167.4pt;padding: 0in 5.4pt;height: 0.2in;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eOver-weight/Obese\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;height: 0.2in;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e2 (5.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75.35pt;padding: 0in 5.4pt;height: 0.2in;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e36 (94.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69.05pt;padding: 0in 5.4pt;height: 0.2in;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e38 (100%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 467.5pt;padding: 0in 5.4pt;height: 16.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:black;background:#D9D9D9;'\u003eInflammation \u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:black;background:#D9D9D9;'\u003e(N=103)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167.4pt;padding: 0in 5.4pt;height: 16.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003ePresent\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;height: 16.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e53 (63.1%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75.35pt;padding: 0in 5.4pt;height: 16.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e31 (36.9%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69.05pt;padding: 0in 5.4pt;height: 16.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e84 (100%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 74.7pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 16.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:12.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026lt;0.001\u003c/span\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167.4pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eAbsent\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e2 (10.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75.35pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e17 (89.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69.05pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e19 (100%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:12px;line-height:200%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e* Test Statistic: Fisher\u0026rsquo;s exact test\u003c/span\u003e\u003c/p\u003e\u003cbr\u003e\u003cp\u003e\u003cstrong\u003eFactors associated with Malnutrition Inflammation Complex Syndrome \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn univariate analysis female gender, longer duration on HD, hypercholesterolaemia, and having HIV associated with the occurrence of MICS. For multivariate analysis, the purposive selection of variables showing a univariate p\u0026lt;0.2 were included in the final regression logistic model. Patients with high cholesterol levels seemed to be protected against the development of MICS. Finally, patients longer on haemodialysis significantly associated with a higher risk for MICS.\u0026nbsp;(Table 3)\u003c/p\u003e\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eTable 3\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:15px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e. Factors associated with Malnutrition Inflammation Complex Syndrome (N=160)\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"width: 4.2e+2pt;margin-left:-.05in;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133.85pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;background: rgb(217, 217, 217);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eCharacteristics\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;background: rgb(217, 217, 217);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:black;'\u003eCOR\u003csup\u003ea \u0026nbsp;\u003c/sup\u003e(95% CI)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;background: rgb(217, 217, 217);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:black;'\u003ep-value\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.65pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;background: rgb(217, 217, 217);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:black;'\u003eAOR\u003csup\u003eb\u0026nbsp;\u003c/sup\u003e(95% CI)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59.15pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;background: rgb(217, 217, 217);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:black;'\u003ep-value\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;background:#D9D9D9;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:black;'\u003eAge groups\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026lt; 60 years\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cu\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026gt;\u003c/span\u003e\u003c/u\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;60 years\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e1.19 (0.62-2.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e0.60\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59.15pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;background:#D9D9D9;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:black;'\u003eGender\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eMale\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eFemale\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e1.88 (0.95-3.72)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e0.07\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e2.03 (0.97-4.25)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59.15pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e0.061\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;background:#D9D9D9;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:black;'\u003eMarital Status\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eLiving with a partner\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eSingle\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e1.19 (0.5-2.84)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e0.69\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59.15pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133.85pt;padding: 0in 5.4pt;height: 38.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;background:#D9D9D9;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:black;'\u003eMode of payment\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eHealth Insurance \u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003ePaying out of pocket\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;padding: 0in 5.4pt;height: 38.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e1.18 (0.42-3.32)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51pt;padding: 0in 5.4pt;height: 38.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e0.75\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.65pt;padding: 0in 5.4pt;height: 38.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59.15pt;padding: 0in 5.4pt;height: 38.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133.85pt;padding: 0in 5.4pt;height: 35.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;background:#D9D9D9;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:black;'\u003eDuration on HD\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cu\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026lt;\u003c/span\u003e\u003c/u\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;4 years\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026gt; 4 years\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;padding: 0in 5.4pt;height: 35.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e4.83 (1.29-18)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51pt;padding: 0in 5.4pt;height: 35.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e0.02\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.65pt;padding: 0in 5.4pt;height: 35.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e5.04 (1.33-19.2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59.15pt;padding: 0in 5.4pt;height: 35.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e0.018\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;background:#D9D9D9;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:black;'\u003eFrequency of HD\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eThrice/week\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eTwice/week\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e1.43 (0.63-3.24)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e0.39\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59.15pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;background:#D9D9D9;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:black;'\u003eVascular Access\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eAV Fistula\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eCentral Venous Catheter\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e1.12 (0.6-2.09)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e0.72\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59.15pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133.85pt;padding: 0in 5.4pt;height: 35.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;background:#D9D9D9;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:black;'\u003eDialysis Adequacy\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eInadequate (URR \u0026lt; 65%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eAdequate \u0026nbsp; (URR \u003cu\u003e\u0026gt;\u003c/u\u003e 65%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;padding: 0in 5.4pt;height: 35.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e1.22 (0.59-2.53)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51pt;padding: 0in 5.4pt;height: 35.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e0.60\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.65pt;padding: 0in 5.4pt;height: 35.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59.15pt;padding: 0in 5.4pt;height: 35.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;background:#D9D9D9;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:black;'\u003eDiabetes Mellitus\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e0.74 (0.4-1.4)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e0.35\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59.15pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;background:#D9D9D9;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:black;'\u003eHypertension\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e0.86 (0.17-4.37)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e0.85\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59.15pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;background:#D9D9D9;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:black;'\u003eHypercholesterolaemia\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eYes (TC \u0026gt; 220mg/dl)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eNo \u0026nbsp; (TC \u003cu\u003e\u0026lt;\u003c/u\u003e 220mg/dl)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e0.13 (0.02-1.1)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e0.06\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e0.11 (0.01-0.97)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59.15pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e0.047\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;background:#D9D9D9;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:black;'\u003eHIV Infection\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e2.53 (0.82-7.78)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e0.11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e2.55 (0.78-8.4)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59.15pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e0.123\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133.85pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;background:#D9D9D9;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:black;'\u003eHBV Infection\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e0.93 (0.24-3.58)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e0.91\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59.15pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:15px;line-height:107%;font-family: \"Calibri\",sans-serif;color:windowtext;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eHosmer Lemeshow Test for Multivariate Logistic regression, p=0.656 \u0026rarr; Goodness of fit present\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003csup\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003ea\u003c/span\u003e\u003c/sup\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp; Crude Odds Ratio (COR) \u0026nbsp; \u003csup\u003eb\u003c/sup\u003e\u0026nbsp; \u0026nbsp;Adjusted Odds Ratio (AOR)\u003c/span\u003e\u003c/p\u003e\u003cbr\u003e\u003cp\u003e\u003cstrong\u003eAssociation between MICS and nutritional, inflammatory, and other laboratory parameters\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients with MICS had significantly lower mean dry-weight, BMI, haemoglobin, albumin, total cholesterol, transferrin, and creatinine levels. The median CRP level was significantly higher in patients with MICS. (Table 4)\u003c/p\u003e\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eTable 4.\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:15px;line-height:150%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;Association between MICS and nutritional, inflammatory and other laboratory parameters\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"width: 4.7e+2pt;border: none;margin-left:5.4pt;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 138.6pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;background: rgb(217, 217, 217);padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eParameters\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;background: rgb(217, 217, 217);padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003eN\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130.5pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;background: rgb(217, 217, 217);padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003eMICS Present (Mean \u003cu\u003e+\u003c/u\u003e SD)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;background: rgb(217, 217, 217);padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003eMICS Absent (Mean \u003cu\u003e+\u003c/u\u003e SD)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;background: rgb(217, 217, 217);padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003ep-value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 6.55in;border: none;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height: 115%;font-family:\"Calibri\",sans-serif;color:black;'\u003eNutritional parameters\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 138.6pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003eDry weight (kg)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27pt;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e160\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130.5pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e56.6 \u003cu\u003e+\u003c/u\u003e 9.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e68.9 \u003cu\u003e+\u003c/u\u003e 10.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e\u0026lt;0.01\u003c/span\u003e\u003csup\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;a\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 138.6pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27pt;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e160\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130.5pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e20.2 \u003cu\u003e+\u003c/u\u003e 2.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e24.4 \u003cu\u003e+\u003c/u\u003e 3.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e\u0026lt;0.01\u003c/span\u003e\u003csup\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;a\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 138.6pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003eAlbumin (g/dl)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27pt;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e160\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130.5pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e3.47 \u003cu\u003e+\u003c/u\u003e 0.49\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e3.94 \u003cu\u003e+\u003c/u\u003e 0.36\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e\u0026lt;0.01\u003c/span\u003e\u003csup\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;a\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 138.6pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003eTotal Cholesterol (mg/dl)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27pt;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e160\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130.5pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e138.7 \u003cu\u003e+\u003c/u\u003e 34.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e163.3 \u003cu\u003e+\u003c/u\u003e 40.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e\u0026lt;0.01\u003c/span\u003e\u003csup\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;a\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 6.55in;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height: 115%;font-family:\"Calibri\",sans-serif;color:black;'\u003eInflammatory markers\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 138.6pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003eTransferrin (mg/dl)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27pt;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e160\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130.5pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e164.1 \u003cu\u003e+\u003c/u\u003e 40.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e217.8 \u003cu\u003e+\u003c/u\u003e 44.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e\u0026lt;0.01\u003c/span\u003e\u003csup\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;a\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 138.6pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003eCRP (mg/l)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27pt;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e103\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130.5pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e22.5 (IQR=12.7-43.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e10.45 (IQR=5.0-16.8)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e\u0026lt;0.01\u003c/span\u003e\u003csup\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003eb\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 138.6pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003eFerritin (ng/ml)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27pt;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e102\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130.5pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e138.2 (IQR=75-349.8)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e100.2 (IQR=49.5-216.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003eNS \u003csup\u003eb\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 6.55in;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height: 115%;font-family:\"Calibri\",sans-serif;color:black;'\u003eOther laboratory parameters\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 138.6pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003eWBC (x 10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27pt;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e160\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130.5pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e5.21 \u003cu\u003e+\u003c/u\u003e 2.78\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e4.93 \u003cu\u003e+\u003c/u\u003e 1.79\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003eNS\u003csup\u003e\u0026nbsp;a\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 138.6pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003eHaemoglobin (g/dl)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27pt;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e160\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130.5pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e8.8 \u003cu\u003e+\u003c/u\u003e 2.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e9.7 \u003cu\u003e+\u003c/u\u003e 1.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e\u0026lt;0.01\u003c/span\u003e\u003csup\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;a\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 138.6pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003ePre-dialysis Cr (\u0026micro;mol/l)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27pt;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e160\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130.5pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e768 \u003cu\u003e+\u003c/u\u003e 316\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e911 \u003cu\u003e+\u003c/u\u003e 412\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e0.016\u003c/span\u003e\u003csup\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;a\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 138.6pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003ePost-dialysis Cr (\u0026micro;mol/l)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27pt;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e160\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130.5pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e267 \u003cu\u003e+\u003c/u\u003e 128\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e361 \u003cu\u003e+\u003c/u\u003e 202\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e\u0026lt;0.01\u003c/span\u003e\u003csup\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;a\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 138.6pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:black;'\u003eUrea Reduction Ratio (URR)%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e160\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e69.9 \u003cu\u003e+\u003c/u\u003e 13.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;background: white;padding: 0in 5.4pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003e70.4 \u003cu\u003e+\u003c/u\u003e 9.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;background: white;padding: 0in 0.5pt;height: 0.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family: \"Calibri\",sans-serif;color:black;'\u003eNS\u003csup\u003e\u0026nbsp;a\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003csup\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003ea\u003c/span\u003e\u003c/sup\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp; Test Statistic: Student\u0026rsquo;s t-test, \u003csup\u003eb\u003c/sup\u003e\u0026nbsp; Test Statistic: Mann-Whitney U test\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003eNS: Not significant (p\u0026gt;0.05), IQR-Interquartile Range\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cstrong\u003e\u003cspan style='line-height:107%;font-family:\"Calibri\",sans-serif;color:windowtext;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eIn this cross-sectional study, 160 haemodialysis patients were recruited to determine the prevalence of Malnutrition Inflammation Complex Syndrome and its associated factors at MNH in Dar es Salaam, Tanzania. More than two-thirds of the patients, 111 (69.4%) were male and the majority 132 (82.5%) were on HD three times per week (as per KDOQI recommendations). The prevalence of MICS was 46.3% and based on severity; MICS was categorized as mild in 24.4% and moderate to severe in 21.9% of the patients. In multivariate analysis, longer duration on HD (\u0026gt;4years) was a significant predictor of MICS and hypercholesterolaemia was a negative predictor of MICS. Patients with MICS had significantly lower mean BMI, albumin, total cholesterol, transferrin, haemoglobin, and creatinine levels.\u003c/p\u003e\n\u003cp\u003eThe prevalence of MICS found in this study may not reliably reflect the situation in Tanzania due to rural-urban disparities in access to dialysis services [3]. A lower prevalence of MICS was noted in this study as compared to 61.2% reported by Matiko in a study conducted among HD patients in Kenya [11]. This difference could be attributed to the adequacy of dialysis as indicated by lower frequency (two times weekly) of dialysis in the study by Matiko as compared to our study in which most patients were getting three times per week dialysis. [11]. Inadequate dialysis can lead to persistently high urea levels, subsequent inflammation, and protein catabolism [12]. However, in this study, HD adequacy as assessed by URR did not associate with MICS. In this study, moderate to severe MICS was noted in 21.9% of HD patients, this is similar to a study from South Africa that reported it to be 22% [24].\u003c/p\u003e\n\u003cp\u003eThe prevalence of underweight HD patients was 16.9%; this was higher than the prevalence of 9.8% reported by Somji et al in a study conducted in Dar es Salaam, Tanzania among HD patients [5]. The prevalence of underweight HD patients found in our study was lower when compared to other studies in African countries; 20.9% in Kenya [11], 29.2% in Niger [25], and 28.3% in Cameroon [26]. Patients with MICS have varying degrees of muscle wasting [12, 17]. In this study, patients with MICS had a mean BMI of 20.2 \u003cu\u003e+\u003c/u\u003e 2.7 kg/m\u003csup\u003e2\u003c/sup\u003e and almost half (48.4%) of the patients with normal BMI had MICS, this implies that BMI alone is not accurate for nutritional assessment in HD patients. The Malnutrition Inflammation Score is a better tool in the assessment of the nutritional status of HD patients and has been found to better correlate with morbidity, quality of life, and mortality [7, 9, 10]. Several factors affect the nutritional status of HD patients; decreased calorie intake, inadequate dialysis, metabolic acidosis, persistent inflammation, and HD-related catabolism [8, 12]. In this study, almost half of the patients had reported some deterioration in dietary intake and almost a third of patients reported gastrointestinal symptoms that may limit adequate dietary intake.\u003c/p\u003e\n\u003cp\u003eIn our study, inflammation was present in 81.6% of the patients; this was lower than that found in the Kenyan study where all patients had raised CRP [11]. Inflammation in HD patients is common and largely attributed to persistent uremia. There are multiple other triggers including HD procedure itself, dialysate quality, and bio-incompatibility of dialysis membranes [4, 9]. The median CRP in our study was significantly higher in patients with MICS, this is consistent with a study done in Mexico [27].\u003c/p\u003e\n\u003cp\u003eIn this study, patients on HD for a longer duration (\u0026gt;4 years) had 5 times the odds of having MICS compared to those on HD for less than 4 years. This finding is consistent with findings from a study by Omari et al who reported a long duration of dialysis to be linked with malnutrition inflammatory syndrome in Palestine [28]. The longer duration on HD therapy results in prolonged exposure of patients to negative effects of HD including dialysis-related inflammation, loss of nutrients, and increased energy expenditure that subsequently can result in malnutrition [12]. This highlights the need for efforts to increase uptake of HD patients into the kidney transplantation program to limit the time spent on chronic HD therapy.\u003c/p\u003e\n\u003cp\u003eLow socioeconomic status and limited access to health insurance significantly influence the adequacy of haemodialysis [4]. We found that the small group of patients who were paying \u0026lsquo;out of pocket\u0026rsquo; (ie. not insured) had slightly higher odds of having MICS. There was a significant difference in the frequency of HD among these two groups; 87.5% of those paying \u0026lsquo;out of pocket\u0026rsquo; versus 9.7% of those who had health insurance were having twice per week HD (p\u0026lt;0.05). Thus health insurance offers the best option for sustaining the adherence to standard long-term haemodialysis.\u003c/p\u003e\n\u003cp\u003eAging has been reported to correlate with MICS but did not show this effect in our study. This might be attributed to the younger age of patients in this study compared to that reported by Rambod et al in a study among HD patients in California who found a higher burden of MICS among older patients on HD [9]. Similarly, other studies on MICS done in Kenya, Brazil, and Mexico also had a younger population; mean age \u0026lt;50years [10, 11, 27]. Some of the possible reasons could be due to variations in the profile of the HD patients which can be affected by differences in survival, recruitment in renal transplantation, and the access to sustainable maintenance HD services. MICS among older patients is attributed largely to co-morbidities including depression that may also affect the dietary intake of these patients.\u003c/p\u003e\n\u003cp\u003eIn this study, the mean total cholesterol level was significantly lower in patients with MICS, which is contrary to a report by Valencia et al that reported no difference in cholesterol levels between dialysis patients with and without MICS in Mexico [27]. Cholesterol is an important nutritional biomarker among patients on HD therapy and hypercholesterolaemia may be protective in these patients unlike the general population [29, 30].\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSerum albumin was noted to be significantly lower among patients with MICS; this was an expected finding consistent with reports from other similar studies [9, 10]. Albumin is a good indicator of protein-energy malnutrition in CKD. Hypoalbuminaemia is attributed to visceral protein loss among patients undergoing HD as well as peritoneal dialysis [12]. Serum creatinine levels have also been reported to be lower among patients with MICS. [10, 27].\u003c/p\u003e\n\u003cp\u003eThe phenomenon of hypocholesterolaemia and hypocreatininaemia among patients on chronic dialysis, accompanied by MICS is referred to as \u0026lsquo;\u003cem\u003ereverse epidemiology\u003c/em\u003e\u0026rsquo;. Reverse epidemiology is paradoxically associated with poor cardiovascular outcomes [29, 30], therefore health care providers providing chronic dialysis therapy should be vigilant and monitor these markers regularly to improve outcomes of chronic dialysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and Limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is the first study in Tanzania to explore the burden of malnutrition and inflammation in HD patients. The other strength of this study was that it also assessed the relationship between nutritional and inflammatory biomarkers with MICS and was shown to be correlated hence reinforces the need for synergistic assessment of these parameters.\u003c/p\u003e\n\u003cp\u003eIn view of the study settings, the data may not be generalized for the whole country. Another limitation of this study was the observer bias while measuring fat and muscle loss. Systematic errors during the measurement of anthropometric indices could have occurred. There might be some selection bias from (i) larger number of health insured patients compared to the small number of patients paying \u0026lsquo;out of pocket\u0026rsquo; (ii) exclusion of a small group of very sick and mentally debilitated patients. This may underestimate the outcome. The CRP test was not done for all patients; this was due to financial restrictions and other logistic challenges.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this cross-sectional study, 160 haemodialysis patients were recruited to determine the prevalence of Malnutrition Inflammation Complex Syndrome and its associated factors at MNH in Dar es Salaam, Tanzania. More than two-thirds of the patients, 111 (69.4%) were male and the majority 132 (82.5%) were on HD three times per week (as per KDOQI recommendations). The prevalence of MICS was 46.3% and based on severity; MICS was categorized as mild in 24.4% and moderate to severe in 21.9% of the patients. In multivariate analysis, longer duration on HD (\u0026gt;4years) was a significant predictor of MICS and hypercholesterolaemia was a negative predictor of MICS. Patients with MICS had significantly lower mean BMI, albumin, total cholesterol, transferrin, haemoglobin, and creatinine levels.\u003c/p\u003e\n\u003cp\u003eThe prevalence of MICS found in this study may not reliably reflect the situation in Tanzania due to rural-urban disparities in access to dialysis services [3]. A lower prevalence of MICS was noted in this study as compared to 61.2% reported by Matiko in a study conducted among HD patients in Kenya [11]. This difference could be attributed to the adequacy of dialysis as indicated by lower frequency (two times weekly) of dialysis in the study by Matiko as compared to our study in which most patients were getting three times per week dialysis. [11]. Inadequate dialysis can lead to persistently high urea levels, subsequent inflammation, and protein catabolism [12]. However, in this study, HD adequacy as assessed by URR did not associate with MICS. In this study, moderate to severe MICS was noted in 21.9% of HD patients, this is similar to a study from South Africa that reported it to be 22% [24].\u003c/p\u003e\n\u003cp\u003eThe prevalence of underweight HD patients was 16.9%; this was higher than the prevalence of 9.8% reported by Somji et al in a study conducted in Dar es Salaam, Tanzania among HD patients [5]. The prevalence of underweight HD patients found in our study was lower when compared to other studies in African countries; 20.9% in Kenya [11], 29.2% in Niger [25], and 28.3% in Cameroon [26]. Patients with MICS have varying degrees of muscle wasting [12, 17]. In this study, patients with MICS had a mean BMI of 20.2 \u003cu\u003e+\u003c/u\u003e 2.7 kg/m\u003csup\u003e2\u003c/sup\u003e and almost half (48.4%) of the patients with normal BMI had MICS, this implies that BMI alone is not accurate for nutritional assessment in HD patients. The Malnutrition Inflammation Score is a better tool in the assessment of the nutritional status of HD patients and has been found to better correlate with morbidity, quality of life, and mortality [7, 9, 10]. Several factors affect the nutritional status of HD patients; decreased calorie intake, inadequate dialysis, metabolic acidosis, persistent inflammation, and HD-related catabolism [8, 12]. In this study, almost half of the patients had reported some deterioration in dietary intake and almost a third of patients reported gastrointestinal symptoms that may limit adequate dietary intake.\u003c/p\u003e\n\u003cp\u003eIn our study, inflammation was present in 81.6% of the patients; this was lower than that found in the Kenyan study where all patients had raised CRP [11]. Inflammation in HD patients is common and largely attributed to persistent uremia. There are multiple other triggers including HD procedure itself, dialysate quality, and bio-incompatibility of dialysis membranes [4, 9]. The median CRP in our study was significantly higher in patients with MICS, this is consistent with a study done in Mexico [27].\u003c/p\u003e\n\u003cp\u003eIn this study, patients on HD for a longer duration (\u0026gt;4 years) had 5 times the odds of having MICS compared to those on HD for less than 4 years. This finding is consistent with findings from a study by Omari et al who reported a long duration of dialysis to be linked with malnutrition inflammatory syndrome in Palestine [28]. The longer duration on HD therapy results in prolonged exposure of patients to negative effects of HD including dialysis-related inflammation, loss of nutrients, and increased energy expenditure that subsequently can result in malnutrition [12]. This highlights the need for efforts to increase uptake of HD patients into the kidney transplantation program to limit the time spent on chronic HD therapy.\u003c/p\u003e\n\u003cp\u003eLow socioeconomic status and limited access to health insurance significantly influence the adequacy of haemodialysis [4]. We found that the small group of patients who were paying \u0026lsquo;out of pocket\u0026rsquo; (ie. not insured) had slightly higher odds of having MICS. There was a significant difference in the frequency of HD among these two groups; 87.5% of those paying \u0026lsquo;out of pocket\u0026rsquo; versus 9.7% of those who had health insurance were having twice per week HD (p\u0026lt;0.05). Thus health insurance offers the best option for sustaining the adherence to standard long-term haemodialysis.\u003c/p\u003e\n\u003cp\u003eAging has been reported to correlate with MICS but did not show this effect in our study. This might be attributed to the younger age of patients in this study compared to that reported by Rambod et al in a study among HD patients in California who found a higher burden of MICS among older patients on HD [9]. Similarly, other studies on MICS done in Kenya, Brazil, and Mexico also had a younger population; mean age \u0026lt;50years [10, 11, 27]. Some of the possible reasons could be due to variations in the profile of the HD patients which can be affected by differences in survival, recruitment in renal transplantation, and the access to sustainable maintenance HD services. MICS among older patients is attributed largely to co-morbidities including depression that may also affect the dietary intake of these patients.\u003c/p\u003e\n\u003cp\u003eIn this study, the mean total cholesterol level was significantly lower in patients with MICS, which is contrary to a report by Valencia et al that reported no difference in cholesterol levels between dialysis patients with and without MICS in Mexico [27]. Cholesterol is an important nutritional biomarker among patients on HD therapy and hypercholesterolaemia may be protective in these patients unlike the general population [29, 30].\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSerum albumin was noted to be significantly lower among patients with MICS; this was an expected finding consistent with reports from other similar studies [9, 10]. Albumin is a good indicator of protein-energy malnutrition in CKD. Hypoalbuminaemia is attributed to visceral protein loss among patients undergoing HD as well as peritoneal dialysis [12]. Serum creatinine levels have also been reported to be lower among patients with MICS. [10, 27].\u003c/p\u003e\n\u003cp\u003eThe phenomenon of hypocholesterolaemia and hypocreatininaemia among patients on chronic dialysis, accompanied by MICS is referred to as \u0026lsquo;\u003cem\u003ereverse epidemiology\u003c/em\u003e\u0026rsquo;. Reverse epidemiology is paradoxically associated with poor cardiovascular outcomes [29, 30], therefore health care providers providing chronic dialysis therapy should be vigilant and monitor these markers regularly to improve outcomes of chronic dialysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and Limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is the first study in Tanzania to explore the burden of malnutrition and inflammation in HD patients. The other strength of this study was that it also assessed the relationship between nutritional and inflammatory biomarkers with MICS and was shown to be correlated hence reinforces the need for synergistic assessment of these parameters.\u003c/p\u003e\n\u003cp\u003eIn view of the study settings, the data may not be generalized for the whole country. Another limitation of this study was the observer bias while measuring fat and muscle loss. Systematic errors during the measurement of anthropometric indices could have occurred. There might be some selection bias from (i) larger number of health insured patients compared to the small number of patients paying \u0026lsquo;out of pocket\u0026rsquo; (ii) exclusion of a small group of very sick and mentally debilitated patients. This may underestimate the outcome. The CRP test was not done for all patients; this was due to financial restrictions and other logistic challenges.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eMalnutrition Inflammation Complex Syndrome (MICS) is prevalent among haemodialysis patients at MNH with a significantly higher burden among those with a long duration of haemodialysis therapy. Hypercholesterolaemia was noted to be protective against the occurrence of MICS consistent with the concept of reverse epidemiology. Hypoalbuminaemia and hypocholesterolemia in haemodialysis patients should prompt further investigations for their nutritional and inflammation status.\u003c/p\u003e\n\u003cp\u003eWe recommend that patients on maintenance haemodialysis should be assessed regularly and treated accordingly for malnutrition and inflammation with more emphasis on patients longer on haemodialysis. We also recommend further studies at our set up to explore the possible causes of the high prevalence of MICS.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eANOVA-Analysis of variance\u003c/p\u003e\n\u003cp\u003eAOR-Adjusted Odds Ratio\u003c/p\u003e\n\u003cp\u003eAVF-Arteriovenous fistula\u003c/p\u003e\n\u003cp\u003eBMI-Body Mass Index\u003c/p\u003e\n\u003cp\u003eCI-Confidence Interval\u003c/p\u003e\n\u003cp\u003eCKD-Chronic Kidney Disease\u003c/p\u003e\n\u003cp\u003eCOR- Crude Odds Ratio\u003c/p\u003e\n\u003cp\u003eCRP-C-reactive protein\u003c/p\u003e\n\u003cp\u003eESRD-End Stage Renal Disease\u003c/p\u003e\n\u003cp\u003eHD-Haemodialysis\u003c/p\u003e\n\u003cp\u003eHBV-Hepatitis B Virus\u003c/p\u003e\n\u003cp\u003eHIV-Human Immunodeficiency Virus\u003c/p\u003e\n\u003cp\u003eIQR-Interquartile Range\u003c/p\u003e\n\u003cp\u003eKDOQI-Kidney Disease Outcome Quality Initiative\u003c/p\u003e\n\u003cp\u003eMIA-Malnutrition Inflammation Atherosclerosis syndrome\u003c/p\u003e\n\u003cp\u003eMICS-Malnutrition Inflammation Complex Syndrome\u003c/p\u003e\n\u003cp\u003eMIS-Malnutrition Inflammation Score\u003c/p\u003e\n\u003cp\u003eMNH-Muhimbili National Hospital\u003c/p\u003e\n\u003cp\u003eMUHAS-Muhimbili University of Health and Allied Sciences\u003c/p\u003e\n\u003cp\u003eNHIF-National Health Insurance Fund\u003c/p\u003e\n\u003cp\u003eTC-Total Cholesterol\u003c/p\u003e\n\u003cp\u003eURR-Urea Reduction Ratio\u003c/p\u003e\n\u003cp\u003eWBC-White cell count\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMUHAS Ethical committee of Research and Publication approved this study with ethical registration number DA.287/298/01A. Permission to conduct this study at MNH was granted by hospitals\u0026rsquo; respective research office. Written informed consent was obtained from all participants before recruitment and enrolled study subjects had the right to withdraw from the study at any point when they felt necessary.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset generated and/or analyzed during the current study is available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePKB prepared the study design, analyzed the data, interpreted the findings and was a main contributor in writing the manuscript. PR, RB, MM, and FF participated in the study design and revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express truthful appreciation to the renal unit at Muhimbili National Hospital for their assistance during the data collection.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTonelli M, Wiebe N, Culleton B, House A, Rabbat C, Fok M, McAlister F, Garg AX. Chronic Kidney Disease and Mortality Risk: A Systematic Review. Journal of the American Society of Nephrology. 2006 Jul; 17(7):2034\u0026ndash;47\u003c/li\u003e\n\u003cli\u003eStanifer JW, Maro V, Egger J, Karia F, Thielman N, Turner EL, Shimbi D, Kilaweh H, Matemu O, Patel UD. The epidemiology of chronic kidney disease in Northern Tanzania: a population-based survey. PloS one. 2015 April 17; 10(4):e0124506.\u003c/li\u003e\n\u003cli\u003eFuria FF, Shoo J, Ruggajo PJ, Kilonzo K, Basu G, Yeates K, Varughese S, Svarstad E, Kisanga O. Developing nephrology services in low income countries: a case of Tanzania. BMC nephrology. 2019 Dec 1; 20(1):378.\u0026nbsp;\u003c/li\u003e\n\u003cli\u003eMeremo AJ, Ngilangwa DP, Mwashambwa MY, Masalu MB, Kapinga J, Tagalile R, Sabi I. Challenges and outcomes of haemodialysis among patients presenting with kidney diseases in Dodoma, Tanzania. BMC nephrology. 2017 Dec 1;18(1):212.\u003c/li\u003e\n\u003cli\u003eSomji SS, Ruggajo P, Moledina S. Adequacy of Hemodialysis and Its Associated Factors among Patients Undergoing Chronic Hemodialysis in Dar es Salaam, Tanzania. International Journal of Nephrology. 2020; 2020.\u003c/li\u003e\n\u003cli\u003eStenvinkel P, Heimbu O, Lindholm B, Kaysen GA, Bergstro J. Are there two types of malnutrition in chronic renal failure ? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrology Dialysis Transplantation. 2000 Jul 1; 15:953\u0026ndash;60.\u003c/li\u003e\n\u003cli\u003eKalantar-Zadeh K, Kopple JD, Block G, Humphreys MH. A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. American Journal of Kidney Diseases. 2001 Dec 1; 38(6):1251\u0026ndash;63.\u003c/li\u003e\n\u003cli\u003eJankowska M, Cobo G, Lindholm B, Stenvinkel P. Inflammation and Protein-Energy Wasting in the Uremic Milieu. InExpanded Hemodialysis. 2017 (Vol. 191, pp. 58-71). Karger Publishers.\u003c/li\u003e\n\u003cli\u003eRambod M, Bross R, Zitterkoph J, Benner D, Pithia J, Colman S, Kovesdy CP, Kopple JD, Kalantar-Zadeh K. Association of Malnutrition-Inflammation Score with Quality of Life and Mortality in Maintenance Hemodialysis Patients: a 5-Year Prospective Cohort Study. American Journal of Kidney Diseases. 2009 Feb 1; 53(2):298\u0026ndash;309.\u003c/li\u003e\n\u003cli\u003eLopes MB, Silva LF, Lopes GB, Penalva MA, Matos CM, Robinson BM, Lopes AA. Additional Contribution of the Malnutrition\u0026ndash;Inflammation Score to Predict Mortality and Patient-Reported Outcomes as Compared With Its Components in a Cohort of African Descent Hemodialysis Patients. Journal of Renal Nutrition. 2017; 27(1):45\u0026ndash;52.\u003c/li\u003e\n\u003cli\u003eMatiko Giabe. Malnutrition Inflammation Complex Syndrome among ambulant End Stage Disease patients on Maintenance Hemodialysis at Kenyatta National Hospital. (Master\u0026rsquo;s dissertation), 2016. University of Nairobi, Kenya. [Cited 2019 April 4] Available from: https://www.semanticscholar.org/paper/Malnutrition-inflammation-complex-syndrome-among-on-Matiko/7ec60df2ae41683e718edaaed58ea9b96d45d4ef\u003c/li\u003e\n\u003cli\u003eCarrero JJ, Stenvinkel P, Cuppari L, Ikizler TA, Kalantar-Zadeh K, Kaysen G, Mitch WE, Price SR, Wanner C, Wang AY, Ter Wee P. Etiology of the Protein-Energy Wasting Syndrome in Chronic Kidney Disease: A Consensus Statement From the International Society of Renal Nutrition and Metabolism (ISRNM). Journal of Renal Nutrition. 2013 Mar 1; 23(2):77\u0026ndash;90.\u003c/li\u003e\n\u003cli\u003eRashid, H, et al. Comparison of C-reactive Protein Levels with Delivered Dose of Kt/V in Patients with End-stage Renal Disease on Maintenance Hemodialysis. Saudi J Kidney Dis Transpl. 2015;26(4):692\u0026ndash;6\u003c/li\u003e\n\u003cli\u003eJofr\u0026eacute; R, Rodriguez-Benitez P, L\u0026oacute;pez-G\u0026oacute;mez JM, P\u0026eacute;rez-Garcia R. Inflammatory syndrome in patients on hemodialysis. Journal of the American Society of Nephrology. 2006 Dec 1; 17(12 suppl 3):S274-80.\u003c/li\u003e\n\u003cli\u003eStenvinkel P, Heimb\u0026uuml;rger O, Paultre F, Diczfalusy U, Wang T, Berglund L, Jogestrand T. Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney international. 1999 May 1; 55(5):1899-911.\u003c/li\u003e\n\u003cli\u003ePecoits‐Filho R, Lindholm B, Stenvinkel P. The malnutrition, inflammation, and atherosclerosis (MIA) syndrome\u0026ndash;the heart of the matter. Nephrology Dialysis Transplantation. 2002 Nov; 17(suppl_11):28-31.\u003c/li\u003e\n\u003cli\u003eKalantar-zadeh K. Recent Advances in Understanding the Malnutrition-Inflammation-Cachexia Syndrome in Chronic Kidney Disease Patients: what is next? InSeminars in dialysis. 2005 Sept; 18(5):365\u0026ndash;9. Oxford, UK: Blackwell Science Inc.\u003c/li\u003e\n\u003cli\u003eBerenson ML, Levine DM, Krehbiel TC. Basic Business Statistics: Concepts and Application. Twelfth Edition. (\u003cem\u003eOnline Topic\u003c/em\u003e) Chapter 8.7: Estimation and Sample Size Determination for Finite Populations. [Cited: 2018 Nov 26] Available: https://wps.pearsoned.co.uk/wps/media/objects/10721/10978811/Ch_08/levine-smume6_topic_08-07.pdf\u003c/li\u003e\n\u003cli\u003eRandom Number Generator. [Internet, Cited 2\u003csup\u003end\u003c/sup\u003e September, 2019]. Available from https://stattrek.com/statistics/random-number-generator.aspx\u003cu\u003e\u0026nbsp;\u003c/u\u003e\u003c/li\u003e\n\u003cli\u003eWorld Health Organization (WHO). Global Strategy on Diet, Physical Activity and Health. [Cited: 2020 July 31] Available from https://www. Who.int/dietphysicalactivity/childhood_what/en/\u003c/li\u003e\n\u003cli\u003ePanichi V et al, Migliori M, De Pietro S, Taccola D, Bianchi AM, Norpoth M, Metelli MR, Giovannini L, Tetta C, Palla R. C Reactive protein in patients with Chronic Renal Diseases, Renal Failure. 2001; 23:3-4, 551-562.\u003c/li\u003e\n\u003cli\u003eKDIGO-- Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Kidney International Supplements (2012) 2, 283-287.\u003c/li\u003e\n\u003cli\u003eNational Kidney Foundation\u0026ndash;Dialysis Outcomes Quality Initiative. Clinical Practice Guidelines and Clinical Practice Recommendations, 2006 Updates. Hemodialysis Adequacy. [Cited: 2020 July 31] Available from http://kidneyfoundation.cachefly.net/professionals/KDOQI/guideline_upHD_PD_VA/hd_guide4.htm\u003c/li\u003e\n\u003cli\u003eAnu Abraham. The Prevalence of Malnutrition Inflammation Complex Syndrome in maintenance hemodialysis patients at Charlotte Maxeke Johannesburg hospital. (Doctoral dissertation), 2019. University of the Witwatersrand, Johannesburg, South Africa. [Cited 2020 April 6]. Available from https://hdl.handle.net/10539/28148\u003c/li\u003e\n\u003cli\u003eMoussa HD, Tondi ZM, Kane Y, Sani MA, Abdou I, Tour\u0026eacute; I, Illa A, Omar AE. Assessing the Nutritional Status of Hemodialysis Patients in Sub-Saharan Africa: Experience of Two Hemodialysis Centers in Niger. Open Journal of Nephrology. 2016 Nov 11; 6(4):161-6.\u003c/li\u003e\n\u003cli\u003eHalle MP, Zebaze PN, Mbofung CM, Kaze F, Mbiatat H, Ashuntantang G, Kengne AP. Nutritional status of patients on maintenance hemodialysis in urban sub-Saharan Africa: evidence from Cameroon. Journal of nephrology. 2014 Oct 1; 27(5):545-53.\u003c/li\u003e\n\u003cli\u003eValencia VC, Rodr\u0026iacute;guez OM, Sandoval ME, Berm\u0026uacute;dez JA, Castellanos SG, de la Cruz CO, C\u0026oacute;rdova MA. Prevalence of malnutrition-inflammation complex syndrome and its correlation with thyroid hormones in chronic haemodialysis patients. Nefrolog\u0026iacute;a (English Edition). 2018 Jan 1; 38(1):57-63.\u003c/li\u003e\n\u003cli\u003eOmari AM, Omari LS, Dagash HH, Sweileh WM, Natour N, Sa\u0026rsquo;ed HZ. Assessment of nutritional status in the maintenance of haemodialysis patients: a cross-sectional study from Palestine. BMC nephrology. 2019 Dec 1; 20(1):92.\u003c/li\u003e\n\u003cli\u003eKalantar-Zadeh K, Block G, Humphreys MH, Kopple JD. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Kidney international. 2003 Mar 1; 63(3):793-808.\u003c/li\u003e\n\u003cli\u003eNurmohamed SA, Nub\u0026eacute; MJ. Reverse epidemiology: Paradoxical observations in haemodialysis patients. Netherlands Journal of Medicine. 2005 Nov 1; 63(10):376\u0026ndash;81.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Malnutrition Inflammation Complex Syndrome, Haemodialysis in Tanzania.","lastPublishedDoi":"10.21203/rs.3.rs-29225/v3","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-29225/v3","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Background: Malnutrition, inflammation, and the combination thereof are predictors of poor outcomes in haemodialysis patients. Malnutrition Inflammation Complex Syndrome (MICS) is an accelerator of atherosclerosis and portends high mortality. Early recognition and treatment of MICS may help to improve the clinical outlook of such patients. This study investigated the prevalence of MICS and its associated factors among patients on maintenance haemodialysis at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania.\nMethods: This was a prospective cross-sectional observational study done among 160 adult patients on maintenance haemodialysis at MNH in 2019. All participants provided written informed consent. Questionnaires were used to collect data and patients’ blood was tested for complete blood count (CBC), C-reactive protein (CRP), ferritin, transferrin, creatinine, urea, total cholesterol, and albumin. The Malnutrition Inflammation Score was used to assess MICS and its severity. Data analysis was done using the SPSS 20 software.\nResults: Of the 160 patients included in the study, 111 (69.4%) were male. The mean age (±SD) of patients and mean duration (±SD) on haemodialysis were 52.2(13.3) years and 22(18) months respectively. MICS was prevalent in 46.3% (mild in 24.4% and moderate to severe in 21.9%).\nLong-term haemodialysis (\u003e4years) was an independent predictor of MICS [Adjusted Odds Ratio, AOR 5.04 (95% CI: 1.33–19.2), p\u003c0.05]. Hypercholesterolaemia was a negative predictor of MICS [AOR 0.11 (95% CI: 0.01-0.97), p\u003c0.05]. Patients with MICS had significantly lower mean body mass index, serum albumin, total cholesterol, transferrin, haemoglobin, and creatinine levels. The presence of MICS was higher in underweight patients and those who had inflammation. Haemodialysis adequacy did not correlate with MICS.\nConclusion: Malnutrition Inflammation Complex Syndrome is relatively common among patients on haemodialysis in Dar es Salaam, Tanzania. Our study has shown a longer duration on haemodialysis to be associated with the occurrence of MICS; on the contrary, having hypercholesterolaemia seems to be protective against MICS consistent with the concept of reverse epidemiology. Patients on haemodialysis should be assessed regularly for malnutrition and inflammation and should receive appropriate and timely treatment to reduce the burden of associated morbidity, and mortality to these patients.","manuscriptTitle":"Prevalence of Malnutrition Inflammation Complex Syndrome among Patients on Maintenance Haemodialysis at Muhimbili National Hospital in Tanzania: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":3,"date":"2020-11-24 15:06:06","doi":"10.21203/rs.3.rs-29225/v3","editorialEvents":[{"type":"communityComments","content":0},{"type":"checksComplete","content":"","date":"2020-11-19T21:00:31+00:00","index":"","fulltext":""},{"type":"decision","content":"Accept","date":"2020-11-17T00:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-11-13T00:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-11-12T23:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":2,"date":"2020-08-18 18:52:23","doi":"10.21203/rs.3.rs-29225/v2","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2020-11-06T00:00:00+00:00","index":1,"fulltext":"Recommendation: Reviewer's comments unavailable pending editorial decision\n"},{"type":"reviewerAgreed","content":"","date":"2020-10-30T12:00:00+00:00","index":1,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-08-14T12:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-08-13T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-08-12T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-08-12T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2020-05-20 17:51:50","doi":"10.21203/rs.3.rs-29225/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2020-07-08T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-07-03T12:00:00+00:00","index":3,"fulltext":"Recommendation: Accept after minor essential revisions\nForm responses:\n---\n\nComments to Author:\n---\nDear authors, in this study you tried to assess the prevalence of Malnutrition Inflammation Complex Syndrome (MICS) and its associated factors among a group of patients on maintenance haemodialysis patients in Tanzania. Although the study is not innovative, it is of scientific interest as it is the first with this subject done in Tanzania.\nMy major comments for your manuscript are:\n1. Please, make a thorough language correction\n2. Improve the description of the methods and tools used in the study, in order to allow independent reproduction of experiments. More specifically:\n\nLines 19-27, it is not clear how did you assess the MICS syndrome and how many semi-structured questionnaires were used to collect patiets' socio-demographic data..\nLine 29, Nutritional status has a broad meaning, which includes anthropometry, biochemical indices, dietary intake and medical histories. Therefore you'd better just say: Body (or somatic) mass was assessed using the body mass index (BMI)\nWere more than one researchers? Was he/she a trained one in anthropometry and the subjective assessment of fat and muscle wasting?\nLine 48: please explain why did you calculate the percentage change\nPage 7, line 4: change the word investigations with a more appropriate one\nPage 7, line 7: please explain why did you assess blood samples both before and after dialysis. Which ones did you use to assess the correlations with MICS.\nPage 7, line 31: How many questionnaires did you use? Please describe briefly the MIS questionnaire and explain how did the dietary intake was assessed. \nPage 8, line 24: \"Patients who were underweight were considered malnourished\". You might use another criterion to consider so, i.e. dietary intake or/and albumin levels\nPage 8, lines 19-36: add references for the cut off values you used\nPage 12, line 39: HIV patient should have been excluded since it is a catabolic disease.\nRestructure the discussion to a more comprehensive/attractive one, for example try to give some explanations of your findings or facts (ie why the patients in Tanzania are younger than in other studies) not just comparing your results to others. * Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Please confirm that you have included your review in the ‘Comments to Author’ box?: **\nYes**\n* Are the methods appropriate and well described to allow independent reproduction of experiments?: **No**\n* Does the work include the necessary controls?: **N/A**\n* Are you able to assess the statistics?: **\nI have been able to assess all of the statistics in this manuscript (please refer to checklist above)**\n* Are the conclusions drawn adequately supported by the data shown?: **No**\n* Quality of written English: **Needs some language corrections before being published**\n* Should the manuscript be highlighted for promotional activity?: **No**\n* Declaration of competing interests: **I declare that I have no competing interests.**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n"},{"type":"editorInvitedReview","content":"","date":"2020-06-21T12:00:00+00:00","index":2,"fulltext":"Recommendation: Accept after discretionary revisions\nForm responses:\n---\n\nComments to Author:\n---\nThis is a cross-sectional study to assess the prevalence of Malnutrition Inflammation Complex Syndrome (MICS), its severity and its associated factors among maintenance HD patients in 2 dialysis facilities under a single centre in Tanzania. It has identified that MICS is present in 46.3% of the study population, with mild MICS in 24.4% and moderate to severe MICS in 21.9% of the patients. There is a significantly higher burden among those with longer duration of dialysis therapy (\u003e4years) while hypercholesterolaemia was a negative predictor of MICS.\n\n1. In the baseline Socio-demographic-clinical characteristics of participants, should mention type of dialysers used in your centre ( ? bio-compatible or not) to the description of frequency of HD and type of HD access as that is likely to affect CRP measurements\n2. In your study, you seem to have defined malnutrition in terms of BMI i.e. subjects who were underweight by BMI - see pg 15 - \"Malnutrition was prevalent in 16.9% of the patients; this was higher than prevalence of 9.8% reported by Somji et al in a study conducted in Dar es Salaam, Tanzania among patients on HD therapy [16]. The prevalence of malnutrition found in our study was lower when compared to other studies in African countries; 20.9% in Kenya [7], 29.2% in Niger [17] and 28.3% in Cameroon [18]. \"\n\nHowever malnutrition is best defined by a combination of parameters, and for the comparison here with the other studies, did they define malnutrition in the same way ? ( or do you mean to compare the proportion of underweight patients since further on, at pg 16 line 9 , you have said that relying on BMI alone may not be accurate for nutritional assessment ).\n\n3. a number of suggested edits :\nAbstract\nLine 14 - grammar: \"This study investigated on the prevalence of MICS..\", remove \"on \"\nLine 27- Suggest to elucidate what blood tests were sent rather than say \" some blood tests \" - complete blood count (CBC), C-reactive protein (CRP), ferritin, transferrin,\ncreatinine, urea, total cholesterol and albumin\nLine 29 - \"The Malnutrition Inflammation Score was used to access( assess) MICS and its severity\nLine 52 - am not clear on the meaning - \"Nutritional status and inflammation significantly \n associated with MICS\" - perhaps could rephrase or remove since both are\n components of MICS \np3 line 4 - to the contrary ( suggest \"on\")\n line 7 -\" seems to be protective against MICS rhyming well with \" - perhaps replace with \" consistent with \"\n\nline 41 - grammar : no need for apostrophe : \"For patients' who\"\nfailed to stand in an upright position on the stadiometer, the length from top of the head to the plantar surface of the foot while lying supine was estimated as their length.\nSuggest can rephrase: \" failed \" as \"were unable to\" \n \" was estimated as their length - \" was taken in lieu of their height \"\nLine 53 - \"..were assessed at the temple, clavicle, scapula, ribs, quadriceps, knee and interosseous ( suggest add the word \" regions \" at end of sentence) .\n\nResults\nFlow diagram (Fig 1) - suggest use word \" declined\" rather than \"denied to participate \" and \" denied written consent \"\n\nPg 9,Line 57 - \"and Anemia was prevalent\" - no need for capitals for \"anaemia\"\n\npg12, line 39 grammar : \" In univariate analysis female gender, long duration on HD, hypercholesterolaemia and having HIV ( were) associated with…\"\n\nDiscussion\nLine 17 - suggest edit : \"The prevalence of MICS was 46.3% and based on\nseverity; MICS was categorized as mild in 24.4% and moderate to severe in 21.9% of the\npatients17 \"\n\n\nLine 21 - Punctuation: \"HD related\" needs hyphen\n\nLine 31 - \" study done in Kenya where by all patients\" could be shortened \" in the Kenyan study where all patients\"\n\nGrammar : Longer duration on HD therapy result(s) in prolonged\nexposure of patients to negative effects of HD including dialysis( hyphen) related inflammation, loss of nutrients and increased energy expenditure that subsequently can result into malnutrition [8].This highlights the need for efforts of ( to) increase uptake of HD patients into a kidney transplantation program to limit the time spent of ( on) chronic HD therapy.\n\nP17 line 4 - Age has been reported to correlate with MICS (but )did not show this effect in our study\n\nLine33 - \"…for patients with chronic renal failure…\" - suggest use \" chronic kidney disease\"\n\nLine 43 - Pre(hyphen) and post( hyphen) dialysis creatinine levels\n\nLine 56 - \"…to improve outcome(s)..\"\n\nConclusions\nJust suggest to change : \"Hypercholesterolaemia was noted to be protective against MICS rhyming well ( consistent ) with the concept of reverse epidemiology. Hypoalbuminaemia and hypocholesterolemia in haemodialysis patients should prompt investigating further ( further investigations) for their nutritional and inflammation status.\"\n\n\"We recommend that patients on maintenance haemodialysis to be assessed regularly\" or\n\" We recommend that patients on maintenance haemodialysis to (should) be assessed regularly\"\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Please confirm that you have included your review in the ‘Comments to Author’ box?: **\nYes**\n* Are the methods appropriate and well described to allow independent reproduction of experiments?: **Yes**\n* Does the work include the necessary controls?: **N/A**\n* Are you able to assess the statistics?: **\nI have been able to assess all of the statistics in this manuscript (please refer to checklist above)**\n* Are the conclusions drawn adequately supported by the data shown?: **Yes**\n* Quality of written English: **Needs some language corrections before being published**\n* Should the manuscript be highlighted for promotional activity?: **No**\n* Declaration of competing interests: **I declare I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n"},{"type":"reviewerAgreed","content":"","date":"2020-06-11T12:00:00+00:00","index":3,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-06-08T12:00:00+00:00","index":1,"fulltext":"Recommendation: Accept after minor essential revisions\nForm responses:\n---\n\nComments to Author:\n---\nI read the interesting paper entitled: 'Prevalence of Malnutrition Inflammation Complex Syndrome among Patients on Maintenance Haemodialysis in Tanzania: A Cross-Sectional Study'. The main aim of this manuscript was to explore the magnitude of MICS among patients on maintenance haemodialysis and its associated factors at MNH in Dar es Salaam, Tanzania. Secondary aim was to determine the predictors/factors associated with Malnutrition Inflammation Complex Syndrome (MICS).\nI organized my review in sections:\n\nIntroduction\nIt is a short review on the current status of knowledge of prevalence of MICS in dialysis patients, with focus on African or African descent patients and on the mechanisms behind the development of MICS in ESRD patients. What s missing in my opinion is more information on the prevalence and incidence of CKD5-D patients in Tanzania, the access to care (is dialysis reimbursed by the healthcare system? From the results I found Health insurance and out of pocket: please clarify) and in general on the dialysis practice in Tanzania (prescriptions……). A brief history on the dialysis treatment development in Tanzania will help to understand the scenario. All these information are then useful for the discussion.\n\nMethods\nIt is a multi center (No. = 2) prospective cross-sectional observational study. Data were actively collected also by an ad hoc questionnaire. Did the study received any approval? (if required..). The center had 284 patients at the beginning of the study (then mentioned 294 in the result section, also at the beginning of the study). A detailed description is included to explain how from this number 160 patients were enough to correctly estimate the prevalence of MICS. Honestly, on the basis of the limited difference between 160 and 294 and mainly to the need to address the secondary aim of the study, I don't understand why the study was not performed on all the patients of the two Renal Units. In fact, in a logistic regression, 60-70% more patients may create a significant positive impact. The definition of the variable included and the statistical analysis have been described in detail.\n\nResults\nAs planned, 160 patients were included in the evaluation. 17.1% of the males and 32.7% of the females resulted with moderate/severe MICS status. Obviously, the presence of MICS was higher in underweight patients. Also inflammation was associated with MICS. Patient with high cholesterol levels seemed to be protected against development of MICS. Finally, patients longer on HD were significantly associated with higher risk for MICS. \n\nDiscussion\nIt is not clear if the reported data, well representing the two centers, actually represents the reality of Tanzania. Then, I think that one of the most interesting part of the study can be the discussion of the results in the light of the socio-economic situation of the patients on dialysis in Tanzania. Are dialysis treatment accessible in rural areas or only in the main cities? How many renal units are in Tanzania? In regards to those patients without health insurance (out of pocket), are those rich or are those who cannot pay the health insurance and after few dialysis sessions quit the treatment? If so, of course they will never survive longer enough to develop MICS. Since this is a cross sectional study, such contradicting results can easily raise. In summary, I would like to understand better the interactions between certain treatment/prescriptions (i.e. 2 sessions a week) and the socio-economical factors behind with the consequence in term of risk for MICS. In regards to the limits of the study, the cross sectional design is good to estimate the prevalence, but it s not clear what kind of prevalence is. I understood that it is only the prevalence of patients currently in treatment in these two renal centers in the city, and this may not represent the full country and of course not represent patients who should be on dialysis since they may be the results of a selection process, being the study actually restricted to those who can somehow afford to be on dialysis. All this should in my opinion considered in the discussion to better interpret the results.\n* Please confirm that you have included your review in the ‘Comments to Author’ box?: **\nYes**\n* Are the methods appropriate and well described to allow independent reproduction of experiments?: **Yes**\n* Does the work include the necessary controls?: **N/A**\n* Are you able to assess the statistics?: **\nI have been able to assess all of the statistics in this manuscript (please refer to checklist above)**\n* Are the conclusions drawn adequately supported by the data shown?: **Yes**\n* Quality of written English: **Acceptable**\n* Should the manuscript be highlighted for promotional activity?: **Yes: If authors clarify the Scenario of dialysis Treatment Access and practice in Tanzania, making possible a better Interpretation of the data, the manuscript can be in my opinion of interest.**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please publish my name with my report.**\n"},{"type":"reviewerAgreed","content":"","date":"2020-06-07T12:00:00+00:00","index":2,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-06-04T12:00:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-06-04T12:00:00+00:00","index":1,"fulltext":""},{"type":"editorAssigned","content":"","date":"2020-06-02T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-05-17T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-05-17T12:00:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"","date":"2020-05-14T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4923b599-91cc-485e-a3c3-b3e8119439f1","owner":[],"postedDate":"November 24th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":320519,"name":"Urology \u0026 Nephrology"}],"tags":[],"updatedAt":"2020-12-06T15:02:47+00:00","versionOfRecord":{"articleIdentity":"rs-29225","link":"https://doi.org/10.1186/s12882-020-02171-3","journal":{"identity":"bmc-nephrology","isVorOnly":false,"title":"BMC Nephrology"},"publishedOn":"2020-11-30 15:01:05","publishedOnDateReadable":"November 30th, 2020"},"versionCreatedAt":"2020-11-24 15:06:06","video":"","vorDoi":"10.1186/s12882-020-02171-3","vorDoiUrl":"https://doi.org/10.1186/s12882-020-02171-3","workflowStages":[]},"version":"v3","identity":"rs-29225","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-29225","identity":"rs-29225","version":["v3"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}