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

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

Author Amparo, Fernanda C. Autor UNIFESP Google Scholar
Kamimura, Maria Ayako Autor UNIFESP Google Scholar
Molnar, Miklos Z. Google Scholar
Cuppari, Lilian Autor UNIFESP Google Scholar
Lindholm, Bengt Google Scholar
Amodeo, Celso Google Scholar
Carrero, Juan J. Google Scholar
Cordeiro, Antonio C. Google Scholar
Institution Dante Pazzanese Inst Cardiol
Universidade Federal de São Paulo (UNIFESP)
Univ Tennessee
Karolinska Inst
Abstract 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.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 m(2); 63% men] referred for the first time to our center. Patients were followed during a median 30 (18-37) months for all-cause mortality.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.MIS appears to be a useful tool to assess PEW in nondialyzed CKD patients. in addition, MIS identified patients at increased mortality risk.
Keywords acute phase response
outcomes
renal disease
undernutrition
uremia
Language English
Sponsor Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
Adib Jatene's Foundation
Swedish Research Council
Grant number FAPESP: 2010/16593-2
Date 2015-05-01
Published in Nephrology Dialysis Transplantation. Oxford: Oxford Univ Press, v. 30, n. 5, p. 821-828, 2015.
ISSN 0931-0509 (Sherpa/Romeo, impact factor)
Publisher Oxford Univ Press
Extent 821-828
Origin http://dx.doi.org/10.1093/ndt/gfu380
Access rights Closed access
Type Article
Web of Science ID WOS:000355315300018
URI http://repositorio.unifesp.br/handle/11600/39064

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