Prognostic Value of the Malnutrition-inflammation Score in Hospitalization and Mortality on Long-term Hemodialysis

Martins, Vítor; Adragão, Teresa; Aguiar, Leila; Pinto, Iola; Dias, Catarina; Figueiredo, Rita; Lourenço, Pedro; Pascoal, Tharick A.; Pereira, Juliana; Pinheiro, Tatiana; Ramião, Inês; Velez, Brígida; Papoila, Ana Luísa; Borges, Nuno; Calhau, Conceição; Macário, Fernando

doi:10.1053/j.jrn.2021.11.002

Cited by 14 publications

(7 citation statements)

References 42 publications

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“…Malnutrition inflammation score depicts the inherent hypercatabolic and inflammation states which are present in a subset of the dialysis population [ 35 ]. An increase in MIS has been associated with mortality in CKD-5D patients [ 41 , 42 ]. Decreased serum magnesium is also associated with increased mortality in dialysis patients [ 43 , 44 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

Adherence to the Mediterranean Diet Is Associated with a More Favorable Left Ventricular Geometry in Patients with End-Stage Kidney Disease

Bacharaki

Petrakis

Kyriazis

et al. 2022

JCM

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Introduction. The aim of the study was to examine the impact of adherence to a Mediterranean-style diet (MD) on left ventricular hypertrophy (LVH) and cardiac geometry in chronic kidney disease patients on dialysis (CKD-5D), given the high prevalence of cardiovascular morbidity in this population. Methods. n = 127 (77 men and 50 women) CKD-5D patients (69 on hemodialysis and 58 on peritoneal dialysis) with a mean age of 62 ± 15 years were studied. An MD adherence score (MDS) (range 0–55, 55 representing maximal adherence) was estimated with a validated method. Echocardiographic LVH was defined by LV mass index (LVMI) > 95 g/m2 in women and > 115 g/m2 in men. Based on LVMI and relative wall thickness (RWT), four LV geometric patterns were defined: normal (normal LVMI and RWT), concentric remodeling (normal LVMI and increased RWT > 0.42), eccentric LVH (increased LVMI and normal RWT), and concentric LVH (increased LVMI and RWT). Results. Patients with LVH (n = 81) as compared to patients with no LVH (n = 46) were older in age (66 ± 13 vs. 55 ± 16 years; p < 0.001) had lower MDS (24 ± 2.7 vs. 25 ± 4.3; p < 0.05) and higher malnutrition-inflammation score (5.0 ± 2.7 vs. 3.9 ± 1.9; p < 0.05), body mass index (27.5 ± 4.9 vs. 24.1 ± 3.5 kg/m2; p < 0.001), prevalence of diabetes (79% vs. 20%; p < 0.05), coronary artery disease (78% vs. 20%; p < 0.05) and peripheral vascular disease (78% vs. 20%; p < 0.01). In a multivariate logistic regression analysis adjusted for all factors mentioned above, each 1-point greater MDS was associated with 18% lower odds of having LVH (OR = 0.82, 95% CI: 0.69–0.98; p < 0.05). MDS was inversely related to LVMI (r = −0.273; p = 0.02), and in a multiple linear regression model (where LVMI was analyzed as a continuous variable), MDS emerged as a significant (Β = −2.217; p < 0.01) independent predictor of LVH. Considering LV geometry, there was a progressive decrease in MDS from the normal group (25.0 ± 3.7) to concentric remodeling (25.8 ± 3.0), eccentric (24.0 ± 2.8), and then concentric (23.6 ± 2.7) group (p < 0.05 for the trend). Conclusions. The greater adherence to an MD is associated with lesser LVH, an important cardiovascular disease risk factor; MD preserves normal cardiac geometry and may confer protection against future cardiac dysfunction in dialysis patients.

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Section: Discussionmentioning

confidence: 99%

Adherence to the Mediterranean Diet Is Associated with a More Favorable Left Ventricular Geometry in Patients with End-Stage Kidney Disease

Bacharaki

Petrakis

Kyriazis

et al. 2022

JCM

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“…With an increasing emphasis on the role of inflammation in malnutrition in dialysis patients, MIS is derived from SGA and includes three new parameters: BMI, serum albumin level, and total iron binding capacity, which makes it a more comprehensive evaluation system than SGA [ 25–27 ]. Similar to SGA, MIS is significantly associated with mortality in dialysis patients [ 28–30 ]. However, MIS has the following advantages over SGA: it is associated with a higher risk of hospitalization in dialysis patients [ 28 ], inflammation and quality of life [ 31 ], and can predict the occurrence of cardiovascular events in dialysis patients [ 32 ].…”

Section: Related Index Of Malnutrition In Dialysis Patientsmentioning

confidence: 99%

“…Similar to SGA, MIS is significantly associated with mortality in dialysis patients [ 28–30 ]. However, MIS has the following advantages over SGA: it is associated with a higher risk of hospitalization in dialysis patients [ 28 ], inflammation and quality of life [ 31 ], and can predict the occurrence of cardiovascular events in dialysis patients [ 32 ]. It is an important tool for identification of early malnutrition in patients with renal failure [ 6 ].…”

Section: Related Index Of Malnutrition In Dialysis Patientsmentioning

confidence: 99%

Progress in the study of nutritional status and selenium in dialysis patients

et al. 2023

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Malnutrition is very common in patients with chronic kidney disease, especially in those on maintenance dialysis. Malnutrition is one of the major factors affecting survival and death of dialysis patients, and reducing their activity tolerance and immunity. There are numerous and interacting risk factors for malnutrition, such as reduced nutritional intake, increased energy expenditure, hormonal disorders, and inflammation. Selenium, in the form of selenoproteins, is involved in many physiological processes in the body and plays an important role in maintaining redox homeostasis. Oxidative stress and infection are very common in dialysis patients, and selenium levels in dialysis patients are significantly lower than those in the healthy population. It has been shown that there is a correlation between selenium levels in hemodialysis patients and their nutrition-related indicators, and that selenium supplementation may improve malnutrition in patients. However, further studies are needed to support this conclusion and there is a lack of basic research to further characterize the potential mechanisms by which selenium may improve malnutrition in dialysis patients. The purpose of this review is to provide a comprehensive overview of factors associated with malnutrition in dialysis patients and to describe the progress of research on nutritional status and selenium levels in dialysis patients.

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“…Recently, the MIS score was also shown to be the best independent predictor of 4-year mortality in HD patients. In fact, MIS mortality predictability is equal to or exceeds many other complex tests of inflammation and nutritional status [ 28 ].…”

Section: Mechanisms Of Inflammation In Ckd and Their Relation To Maln...mentioning

confidence: 99%

Evolving Concepts on Inflammatory Biomarkers and Malnutrition in Chronic Kidney Disease

et al. 2022

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While patient care, kidney replacement therapy, and transplantation techniques for chronic kidney disease (CKD) have continued to progress, the incidence of malnutrition disorders in CKD appears to have remained unchanged over time. However, there is now a better understanding of the underlying pathophysiology according to the disease background, disease stage, and the treatment received. In CKD patients, the increased production of proinflammatory cytokines and oxidative stress lead to a proinflammatory milieu that is at least partially responsible for the increased morbidity and mortality in this patient population. New insights into the pathogenic role of innate immunity and the proinflammatory cytokine profile, characterized, for instance, by higher levels of IL-6 and TNF-α, explain some of the clinical and laboratory abnormalities observed in these patients. In this article, we will explore currently available nutritional–inflammatory biomarkers in distinct CKD populations (hemodialysis, peritoneal dialysis, transplantation) with a view to evaluating their efficacy as predictors of malnutrition and their involvement in the common proinflammatory process. Although there is a direct relationship between inflammatory-nutritional status, signs and symptoms [e.g., protein-energy wasting (PEW), anorexia], and comorbidities (e.g., atheromatosis, atherosclerosis), we are in need of clearly standardized markers for nutritional-inflammatory assessment to improve their performance and design appropriate bidirectional interventions.

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Prognostic Value of the Malnutrition-inflammation Score in Hospitalization and Mortality on Long-term Hemodialysis

Cited by 14 publications

References 42 publications

Adherence to the Mediterranean Diet Is Associated with a More Favorable Left Ventricular Geometry in Patients with End-Stage Kidney Disease

Adherence to the Mediterranean Diet Is Associated with a More Favorable Left Ventricular Geometry in Patients with End-Stage Kidney Disease

Progress in the study of nutritional status and selenium in dialysis patients

Evolving Concepts on Inflammatory Biomarkers and Malnutrition in Chronic Kidney Disease

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