Background: Anemia is a frequent complication of end-stage renal disease. Anemia may be caused by a reduction in erythropoietin in end-stage renal disease (ESRD). This work aimed to focus on evaluating the relationship between malnutrition-inflammation scores (MIS), anemia management, and resistance to erythropoietin therapy in patients with chronic kidney disease undergoing hemodialysis. Methods: This was a prospective cross-sectional, non-randomized research performed in the Internal Medicine Department of Faculty of Medicine, Zagazig University Hospitals and Nasr City Police Hospital at a duration of two years from September 2019 to September 2021.

Results: High MIS is strongly correlated (p<0.05) with poor nutritional and inflammatory markers, such as low albumin, high CRP, and high ferritin. MIS is negatively correlated with hemoglobin and TIBC, reflecting its impact on anemia. Erythropoietin resistance is closely linked to elevated MIS, inflammation (CRP, ferritin), and malnutrition (albumin).

Conclusion: The study highlights the critical role of malnutrition and inflammation in the management of chronic kidney disease (CKD) patients undergoing hemodialysis. Elevated MIS is associated with poor nutritional status (low serum albumin) and heightened inflammatory markers (CRP, serum ferritin, and triglycerides). Malnutrition and inflammation exacerbate anemia and impair response to erythropoietin therapy.