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

Fernanda C. Amparo, Maria A. Kamimura, M. Molnár, Lilian Cuppari, Bengt Lindholm, Celso Amodeo, Juan J. Carrero, Antonio C. Cordeiro

Research output: Contribution to journalArticle

20 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

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Chronic Renal Insufficiency
Malnutrition
Inflammation
Mortality
Orosomucoid
Proteins
Structural Models
Ferritins
Nutritional Status
Electric Impedance
Glomerular Filtration Rate
Proportional Hazards Models
C-Reactive Protein
Fibrinogen
Urea
Biomarkers

Keywords

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

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Medicine(all)

Cite this

Diagnostic validation and prognostic significance of the Malnutrition-Inflammation Score in nondialyzed chronic kidney disease patients. / Amparo, Fernanda C.; Kamimura, Maria A.; Molnár, M.; Cuppari, Lilian; Lindholm, Bengt; Amodeo, Celso; Carrero, Juan J.; Cordeiro, Antonio C.

In: Nephrology Dialysis Transplantation, Vol. 30, No. 5, 01.05.2015, p. 821-828.

Research output: Contribution to journalArticle

Amparo, Fernanda C. ; Kamimura, Maria A. ; Molnár, M. ; Cuppari, Lilian ; Lindholm, Bengt ; Amodeo, Celso ; Carrero, Juan J. ; Cordeiro, Antonio C. / Diagnostic validation and prognostic significance of the Malnutrition-Inflammation Score in nondialyzed chronic kidney disease patients. In: Nephrology Dialysis Transplantation. 2015 ; Vol. 30, No. 5. pp. 821-828.
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