Comparison Analysis of Nutritional Scores for Serial Monitoring of Nutritional Status in Hemodialysis Patients

Abstract

SummaryBackground and objectives This study aimed to compare the longitudinal performance of the malnutritioninflammation score (MIS) and the geriatric nutritional risk index (GNRI), two nutritional scores for patients on maintenance hemodialysis.Design, setting, participants, & measurements Nutritional scores, dietary intake, biochemical markers, and body composition analysis were performed at baseline and at 6, 12, and 18 months after enrollment (which took place from January through December 2006) on 75 prevalent hemodialysis patients (43% women, mean age 64.8611.9 years). The patients underwent simultaneous MIS and GNRI assessments calculated by two independent examiners from baseline. The study period was 46.8616.4 months.Results GNRI had higher interobserver agreement (weighted k-score 0.98) than MIS (weighted k-score 0.62). Longitudinally, a 1-unit increase in MIS was associated with a 0.41 kcal/kg per day reduction in daily energy intake (P,0.001) and with a 0.014 g/kg per day reduction in nPNA (P=0.02). GNRI did not correlate with the change over time of dietary intake. Longitudinal changes of both scores were associated with appropriate changes over time in levels of nutritional biomarkers, inflammation (IL-6), and body composition parameters. Both scores expressed significant associations with prospective hospitalization, whereas only MIS was associated with mortality in this cohort. The multivariate Cox proportional hazard ratio was 1.15 for death for each 1-unit increase in the MIS (95% confidence interval, 1.03-1.3; P=0.02).Conclusions Both MIS and GNRI are valid tools for longitudinal assessment of hemodialysis patients' nutritional status. MIS has lower interobserver reproducibility than GNRI; however, MIS is more comprehensive than GNRI.

Relationships of Total Lymphocyte Count and Subpopulation Lymphocyte Counts with the Nutritional Status in Patients Undergoing Hemodialysis/Peritoneal Dialysis

“…2 According to another recent study, GNRI is a valid tool for the longitudinal assessment of nutritional status in HD patients. 11 Our previous study also showed similar findings. 12 In the current study, at three months, total cholesterol and BUN, both of which are nutritional indicators, were higher in the group with a higher GNRI at three months.…”

Longitudinal Study of Serum Uric Acid, Nutritional Status, and Mortality in Maintenance Hemodialysis Patients

“…With regard to nutritional status, most of studies have shown that MHD associates with a significant decline in certain laboratory nutritional parameters, including albumin (26,27), as well as anthropometric measurements (27,28). GNRI, an objective and simple nutritional index, has also been reported to decrease significantly with time in patients on MHD in a recent prospective longitudinal study (29). The longitudinal behavior of SUA may be explained as follows: it is a proposed nutritional marker in the MHD population as reported in a recently published prospective observational study (15), and changes in SUA levels over time may simply follow changes in nutritional status.…”

“…Fourth, the overall nutritional status was assessed by GNRI, which may not be the ideal nutritional marker in the MHD population. Despite the observed significant associations of GNRI with dietary intake, laboratory markers of nutrition, body composition, and prognosis (29,44), the only validation study of GNRI as a nutritional marker in the MHD population was conducted in Japanese patients on HD (45). Fifth, the proportion of cardiovascular deaths may be underestimated, because the causes of death were extracted from patient records and were not confirmed by autopsies.…”

Interaction Between Geriatric Nutritional Risk Index and Decoy Receptor 3 Predicts Mortality in Chronic Hemodialysis Patients

“…Baseline nutritional status was assessed in all participants at enrolment.Because MIS is the most validated nutritional method, it is used as the reference standard for the presence of PEW [13]. MIS was calculated from 7 categories of the modified SGA score together with the 3 additional components of body mass index (BMI), serum albumin, and serum total iron-binding capacity (TIBC) [3,14].…”

“…The sum of ten MIS categories ranges from 0 (normal) to 30 (severely malnourished). The cutoff value for MIS-positive status (malnutrition) was defined as 6 or more because patients with MIS ≥6 were associated with increased morbidity and mortality compared with patients who had MIS <6 in previous studies [4,13]. …”