MALNUTRITION-INFLAMMATION SCORE PREDICTS SURVIVAL IN HEMODIALYSIS PATIENS
Abstract
The short life span of dialysis patients is induced by traditional cardiovascular and non-traditional dialysis related factors such as inflammation, oxidative stress, protein energy malnutrition. Malnutrition-Inflammation Score (MIS) has been proposed as a new quantitative system for assessment of malnutrition and inflammation. In this study we sought to investigate the association of MIS and five-year-mortality in dialysis patients.
In a prospective study were included 131 prevalent dialysis patients. Kalantar-Zadeh method (7) was used to calculate the malnutrition score. Patients were followed for five years. Kaplan-Meier survival and Cox-proportional mortality analysis were performed according to higher and lower malnutrition inflammation score, by cut-off value of 7.
The mean age of study participants was 55.45 years and mean dialysis vintage was 111.04 months. After follow-up of 60 months 55 (42%) patients died from all-cause mortality and out of those 65% (36) were cardiovascular deaths. In comparative analysis among the survived and died patients, none of the inflammatory or nutritional variables such as CRP, albumin, creatinine, BMI or SGA significantly differed. There was a significantly longer survival among patients with lower MIS in respect of all-cause and cardiovascular mortality [49.28 ±1.88 vs. 39.29±3.53 months, p=0.011], [52.20 ±1.7 vs. 45.07 ±3.41, p=0.045], respectively. MIS emerged as a powerful predictor of all-cause and cardiovascular mortality through Cox regression analysis: HR 1.97 95%CI:(1.15 – 3.38), p=0.013; HR 1.063 95%CI-0.952-1.186, p=0.055), respectively.
The malnutrition-inflammation score is a useful tool to predict outcomes. The key to improving survival and quality of life in dialysis patients could be gained by understanding of the malnutrition-inflammation complex syndrome and its interactions with cardiovascular disease and outcome.
References
embracing the future. Annual report: Treatment of End-Stage Organ Failure in Canada, 2003 to 2012.Can J
Kidney Health Dis. 2014; 1:26.
2. Covic, A., Gusbeth-Tatomir, P., and Goldsmith, D. Negative outcome studies in end-stage renal disease: how
dark are the storm clouds?. Nephrol Dial Transplant. 2008; 23: 56–61.
3. Saran R, Li Y, Robinson B, et al. US Renal Data System 2015 Annual Data Report: epidemiology of kidney
disease in the United States. Am J Kidney Dis. 2016; 67(3) (suppl 1):S1-S434.
4. Autier, P., Boniol, M., LaVecchia, C. et al. Disparities in breast cancer mortality trends between 30 European
countries: retrospective trend analysis of WHO mortality database. BMJ. 2010; 341: 448.
5. Mokdad, A.H., Dwyer-Lindgren, L., Fitzmaurice, C. et al. Trends and patterns of disparities in cancer mortality
among US counties, 1980-2014. JAMA. 2017; 31(7): 388–406.
6. Rattanasompattikul M, Chanchairujira K, On-Ajyooth L, Chanchairujira T. Evaluation of atherosclerosis,
arterial stiffness and related risk factors in chronic hemodialysis patients in Siriraj Hospital. J Med Assoc Thai.
2011; 94 Suppl 1:S117-24.
7. Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH. A malnutrition-inflammation score is correlated with
morbidity and mortality in maintenance hemodialysis patients. Am J Kidney Dis. 2001; 38(6):1251–1263.
8. Landray MJ, Thambyrajah J, McGlynn FJ, et al. Epidemiological evaluation of known and suspected
cardiovascular risk factors in chronic renal impairment. Am J Kidney Dis 2001; 38:537.
9. Rambod M, Bross R, Zitterkoph J, et al. Association of Malnutrition-Inflammation Score with quality of life
and mortality in hemodialysis patients: a 5-year prospective cohort study. Am J Kidney Dis. 2008; 53(2):298-
309.
10. Pisetkul C1, Chanchairujira K, Chotipanvittayakul N, Ong-Ajyooth L, Chanchairujira T. Malnutrition-
inflammation score associated with atherosclerosis, inflammation and short-term outcome in hemodialysis
patients. J Med Assoc Thai. 2010; 93 Suppl 1:S147-56.
11. Borges M, Clementoni C et al. Malnutrition Inflammation Score cut-off predicting mortality in maintenance
hemodialysis patients. Clin. Nutr. ESPEN 2017; 17:63-7.
12. Lopes MB, Silva LF, Lopes GB et al. Additional Contribution of the Malnutrition-Inflammation Score to Predict
Mortality and Patient-Reported Outcomes as Compared With Its Components in a Cohort of African Descent
Hemodialysis Patients. J Ren Nutr.2017; 27(1):45-52.
13. Perez V. Are Nutritional Composed Scoring Systems and Protein-Energy Wasting Score Associated With
Mortality in Maintenance Hemodialysis Patients?J Ren Nutr. 2016; 26(3):183-9.
14. Epifanio APS, Balbino KP, Ribeiro KP et al. Clinical-nutritional, inflammatory and oxidative stress predictors in
hemodialysis mortality: a review. Nutr Hosp.2018; 35(2):461-8.
