{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T19:05:21Z","timestamp":1789153521150,"version":"build-2803163510"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T00:00:00Z","timestamp":1678406400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>The bioelectrical impedance analysis-measured ratio of extracellular water (ECW) to intracellular water (ICW) reflects fluid volume and malnutrition. It may be an indicator of protein-energy wasting and muscle wasting in hemodialysis patients. We examined the association between the ECW\/ICW ratio and simplified creatinine index, which is a new surrogate marker of protein-energy wasting and muscle wasting, and whether their combination can accurately predict mortality. A total of 224 patients undergoing hemodialysis for more than 6 months and having undergone bioelectrical impedance analysis for the assessment of body composition were included. Patients were divided into two groups based on the cut-off values of the ECW\/ICW ratio (0.57) and simplified creatinine index (20.4 mg\/kg\/day) for maximumly predicting mortality. Thereafter, they were cross-classified into four groups with each cut-off point. The ECW\/ICW ratio was independently associated with the simplified creatinine index (\u03b2 = -0.164; P = 0.042). During a follow-up of 3.5 years (2.0\u20136.0 years), 77 patients died. A higher ECW\/ICW ratio (adjusted hazard ratio, 3.66, 95% confidence interval 1.99\u20136.72, P &lt;0.0001) and lower simplified creatinine index (adjusted hazard ratio, 2.25, 95% confidence interval 1.34\u20133.79, P = 0.0021) were independently associated with an increased risk of all-cause mortality. The adjusted hazard ratio for the higher ECW\/ICW ratio and lower simplified creatinine index group vs. the lower ECW\/ICW ratio and higher simplified creatinine index group was 12.22 (95% confidence interval 3.68\u201340.57, p &lt;0.0001). Furthermore, the addition of the ECW\/ICW ratio and simplified creatinine index to the baseline risk model significantly improved the C-index from 0.831 to 0.864 (p = 0.045). In conclusion, the ECW\/ICW ratio may be a surrogate marker of muscle wasting. Moreover, combining the ECW\/ICW ratio and simplified creatinine index may improve the accuracy of predicting all-cause mortality and help stratify the mortality risk of hemodialysis patients.<\/jats:p>","DOI":"10.1371\/journal.pone.0282864","type":"journal-article","created":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T18:24:15Z","timestamp":1678472655000},"page":"e0282864","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":14,"title":["Ratio of extracellular water to intracellular water and simplified creatinine index as predictors of all-cause mortality for patients receiving 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