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

Fernanda C. Amparo, Maria A. Kamimura, Miklos Z. Molnar, Lilian Cuppari, Bengt Lindholm, Celso Amodeo, Juan J. Carrero, Antonio C. Cordeiro

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background 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. Methods 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 m2; 63% men] referred for the first time to our center. Patients were followed during a median 30 (18-37) months for all-cause mortality. Results 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. Conclusions MIS appears to be a useful tool to assess PEW in nondialyzed CKD patients. In addition, MIS identified patients at increased mortality risk.

Original languageEnglish
Pages (from-to)821-828
Number of pages8
JournalNephrology Dialysis Transplantation
Volume30
Issue number5
DOIs
Publication statusPublished - May 1 2015

Keywords

  • acute phase response
  • outcomes
  • renal disease
  • undernutrition
  • uremia

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Fingerprint Dive into the research topics of 'Diagnostic validation and prognostic significance of the Malnutrition-Inflammation Score in nondialyzed chronic kidney disease patients'. Together they form a unique fingerprint.

  • Cite this