Nakata_2026_BMC.Nephrol__

BACKGROUND: Assessing nutrition-related change in maintenance hemodialysis is challenging because commonly used biomarkers such as serum albumin are influenced by inflammation and volume status. Prescribed dry weight (DW) is a clinically important treatment target, but longitudinal DW change may reflect both volume-related and nutrition-related body-mass change. Serum butyrylcholinesterase (BChE), a liver-synthesized protein, may better capture nutrition-related change in this setting. We examined whether longitudinal change in BChE was associated with concurrent change in prescribed DW and compared this association with that of albumin while accounting for volume-related change using human atrial natriuretic peptide (hANP). METHODS: We conducted a single-center retrospective longitudinal observational study of adults receiving maintenance hemodialysis between September 2024 and December 2025. Monthly clinical data were used to calculate concurrent 3-month changes, expressed as log-ratios (deltalog), in BChE, albumin, hANP, and prescribed DW. The primary analysis evaluated the association between deltalogBChE and concurrent deltalogDW across repeated 3-month windows using linear regression with patient-level cluster-robust standard errors. Multivariable models included deltalogBChE, deltalogAlb, and deltaloghANP. RESULTS: Ninety-six patients were included, contributing 1,248 concurrent 3-month windows. In multivariable longitudinal models, deltalogBChE was independently associated with concurrent deltalogDW (standardized beta = 0.115; P = 0.005), whereas deltalogAlb was not (P = 0.39). deltaloghANP was also independently associated with deltalogDW (standardized beta = 0.144; P = 0.001). CONCLUSIONS: In maintenance hemodialysis, longitudinal change in serum BChE was associated with concurrent prescribed DW change independent of albumin and hANP. These preliminary findings suggest that BChE may help contextualize prescribed DW changes as a nutrition-related biochemical signal, but prospective validation using standardized body-composition assessment is needed.