Validity of nutrition risk index as a malnutrition screening tool compared with subjective global assessment in end-stage renal disease patients on peritoneal dialysis

Abstract

We undertook this study to compare subjective global assessment (SGA) and nutrition risk index (NRI) as malnutrition screening tools in peritoneal dialysis (PD) patients. Nutrition status of the patients was categorized into low, moderate and high risk of malnutrition based on both NRI and SGA. The sensitivity, specificity and predictive values of NRI were compared with SGA, an already validated tool of nutrition status assessment in PD patients. Two hundred and eighty-three end-stage renal disease patients (age 50.02 ± 13.76 years; 204 males, 150 diabetic) were included. Based on SGA, 71/283 (25.08%) had normal nutrition, 192/283 (67.84%) mild–moderate and 20/283 (7.07%) severe malnutrition. Based on NRI, 38/283 (13.43%) patients had normal nutritional status, 193/283 (68.20%) mild-moderate and 52/283 (18.37%) severe malnutrition. Twenty-three of 283 (8.1%) were correctly classified as normal by NRI (true negative) and 197/283 (69.6%) as malnourished (true positive), 15/283 (5.3%) as false negative, 48/283 (16.96%) were misclassified as malnourished (false positive). NRI has sensitivity of 92.9% and specificity of 32.39%. Positive predictive value and Negative predictive values (NPVs) of NRI are 80.41% and 60.53%, respectively. Accuracy of the test is 78%. The receiver operating characteristic curve of NRI is 0.63. To conclude, NRI carries high sensitivity but low specificity as compared to SGA. It can be used as screening tool but not as a diagnostic tool for assessment of nutritional status in PD patients because of its low specificity and NPV.

Geriatric nutritional risk index predicts poor outcomes in patients with acute ischemic stroke - Automated undernutrition screen tool

“…Given that most of stroke patients are over 60 years old and have underlying disease, the use of GNRI for stroke patients is worth considering. In another aspect, the GNRI has a high sensitivity for malnutrition compared to other reliable assessment tools [22]. Approximately 20% of the stroke patients had a moderate or severe risk of malnutrition at admission in our study based on the GNRI result, which was within the range reported previously [23].…”

Combined Assessment of Nutritional Status in Patients With Peritoneal Dialysis Using Bioelectrical Impedance Vectors and Malnutrition Inflammation Score/ Evaluación Combinada Del Estado De Nutrición en Pacientes Con Diálisis Peritoneal Mediante Vectores De Impedancia Bioeléctrica Y Puntaje De Inflamación Y Desnutrición

“…However, when considering other studies, the prevalence of malnutrition by MIS in our population is similar to that reported in the literature (20). The prevalence of malnutrition diagnosed by BIVA was 24%, which is lower than that found in other studies with different diagnostic tools (18)(19)(20)(21). To our knowledge, there is no other study that has made the diagnosis of malnutrition using impedance vectors, so we cannot know if the prevalence reported here is similar to that of other populations.…”

“…In this study we found a prevalence of malnutrition diagnosed by MIS of 38%, considerably lower than that found by Singh et al (18) in Malaysia and Prasad et al (19) in India, where the prevalence of malnutrition reached 90% and 74.9%, respectively. However, when considering other studies, the prevalence of malnutrition by MIS in our population is similar to that reported in the literature (20).…”

Subjective global assessment of the patients of chronic kidney disease undergoing dialysis

“…20 It can be used as screening tool but not as a diagnostic tool for assessment of nutritional status in peritoneal dialysis patients because of its low specificity and NPV.…”