Diagnostic validation and prognostic significance of the Malnutrition-Inflammation Score in nondialyzed chronic kidney disease patients

Author(s)

Amparo, Fernanda C. ^{[1, 2]} ; Kamimura, Maria A. ^[2] ; Molnar, Miklos Z. ^[3] ; Cuppari, Lilian ^[2] ; Lindholm, Bengt ^{[4, 5]} ; Amodeo, Celso ; Carrero, Juan J. ^{[4, 5, 6]} ; Cordeiro, Antonio C. ^[7]

Affiliation

^[1] Dante Pazzanese Inst Cardiol, Dept Nutr, Sao Paulo - Brazil

^[2] Univ Fed Sao Paulo, Div Nephrol, Nutr Program, Sao Paulo - Brazil

^[3] Univ Tennessee, Hlth Sci Ctr, Div Nephrol, Dept Med, Memphis, TN - USA

^[4] Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Renal Med, Stockholm - Sweden

^[5] Karolinska Inst, Dept Clin Sci Intervent & Technol, Baxter Novum, Stockholm - Sweden

^[6] Karolinska Inst, Ctr Mol Med, Stockholm - Sweden

^[7] Dante Pazzanese Inst Cardiol, Dept Hypertens & Nephrol, Sao Paulo - Brazil

• Document type: Journal article
• Source: Nephrology Dialysis Transplantation; v. 30, n. 5, p. 821-828, MAY 2015.
• Web of Science Citations: 19

Abstract

Malnutrition and inflammation are highly prevalent and intimately linked conditions in chronic kidney disease (CKD) patients that lead to a state of protein-energy wasting (PEW), the severity of which can be assessed by the Malnutrition-Inflammation Score (MIS). Here, we applied MIS and validated, for the first time, its ability to grade PEW and predict mortality in nondialyzed CKD patients. We cross-sectionally evaluated 300 CKD stages 3-5 patients {[}median age 61 (53-68) years; estimated glomerular filtration rate 18 (12-27) mL/min/1.73 m(2); 63% men] referred for the first time to our center. Patients were followed during a median 30 (18-37) months for all-cause mortality. A worsening in MIS scale was associated with inflammatory biomarkers increase (i.e. alpha-1 acid glycoprotein, fibrinogen, ferritin and C-reactive protein) as well as a progressive deterioration in various MIS-independent indicators of nutritional status based on anthropometrics, dynamometry, urea kinetics and bioelectric impedance analysis. A structural equation model with two latent variables (assessing simultaneously malnutrition and inflammation factors) demonstrated good fit to the observed data. During a follow-up, 71 deaths were recorded; patients with higher MIS were at increased mortality risk in both crude and adjusted Cox models. MIS appears to be a useful tool to assess PEW in nondialyzed CKD patients. In addition, MIS identified patients at increased mortality risk. (AU)

• FAPESP's process: 10/16593-2 - Association between traditional, novel and uremic related risk factors and morbidity/mortality (all-cause and cardiovascular) in chronic kidney disease patients
• Grantee: Antonio Carlos Cordeiro Silva Júnior
• Support Opportunities: Regular Research Grants