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Background: Protein-energy wasting (PEW) is common in patients with chronic kidney disease (CKD), and is associated with high morbidity and mortality. Malnutrition-Inflammation Score (MIS) has significant correlations with prospective hospitalization and mortality, as well as measures of anemia, inflammation, and nutrition in dialysis patients., Material and Methods: The study was conducted on 100 adult patients of CKD selected from K&D clinic PGIMS, Rohtak. All the patients went under detailed socioeconomic, clinical, biochemical and radiological examination. The average of three measurements of body weight, height, triceps skin fold thickness (TST), and mid-arm muscle circumference (MAMC) were measured in all patients. MIS was calculated for all the patients., Results: Out of total 100 patients, 64 were male and 36 were female. Overall, the prevalence of malnutrition was 60%. A total of 42%, 16% and 2% patients had mild, moderate and severe malnutrition respectively. Our study also shows significant association between staging of CKD (3 to 5-D) and MIS. A significant negative correlation was found between MIS and factors such as BMI, eGFR, serum calcium and hemoglobin levels. A significant positive correlation of this score was found with blood urea serum creatinine, serum uric acid, serum potassium and serum phosphate. Multivariate analysis showed significant association between MIS and serum albumin, TIBC, BMI, family income and hs-CRP., Conclusion: Assessment of key components of malnutrition and inflammation early in disease course will help to identify high risk subjects in whom modifying these predictors will help in providing active and healthy life for CKD patients.

Background & Aims: Studies assessing the performance of 7-point subjective global assessment (7p-SGA) and malnutrition inflammation score (MIS) to assess longitudinal changes in nutritional status are lacking. Thus, we aimed to investigate whether longitudinal changes in 7p-SGA and MIS were associated with changes in objective parameters of nutritional status, as well as to evaluate the prognostic value of 7p-SGA and MIS on hospitalization events., Methods: One hundred and four patients aged ≥60 years (70.2% male, age: 70.9 ± 6.9 years) on maintenance hemodialysis were studied. The 7p-SGA, MIS and objective parameters of nutritional status (anthropometrics, muscle strength, body cell mass and phase angle assessed by bioelectrical impedance analysis - BIA, albumin, creatinine and C-reactive protein) were assessed at baseline and 12 months after the enrollment. Follow-up for hospitalization events were carried out at 13.0 (interquartile range: 3.0; 21.0) months after the first year of enrollment., Results: Analysis of repeated measures, stratified by gender, and adjusted for age and dialysis vintage, showed that for men, a 1-unit change in 7p-SGA was significantly associated (P < 0.05) with changes in all anthropometrics, muscle strength and BIA parameters. For women, changes in 7p-SGA were associated with most of the anthropometrics, muscle strength and BIA parameters. Similarly, for both genders, changes in MIS were associated with changes in most anthropometric, muscle strength, BIA measurements, albumin (only for men), and creatinine (only for women). In addition, when assessed by 7p-SGA, patients with a declining nutritional status had a higher relative risk (RR) of hospitalization events [RR: 2.08 (95 CI: 1.44-2.99; P < 0.001)] and length of hospital stay (days) [RR: 3.73 (95 CI: 3.29-4.22; P < 0.001)]., Conclusions: Longitudinal changes in 7p-SGA and MIS were associated with changes in most of the objective parameters tested during 12 months of follow-up. Furthermore, a declining 7p-SGA score predicted a greater number of hospitalization events and days of hospital stay., (Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: Malnutrition is a strong predictor of mortality on hemodialysis patients, especially when it is associated with inflammation. Malnutrition Inflammation Score (MIS) is a simple and low cost tool which assesses the presence of malnutrition associated with inflammation. Therefore, the aim is to evaluate if MIS is associated with mortality in patients on maintenance hemodialysis and establish a cut-off to predict mortality at different follow-up periods., Methods: Observational retrospective cohort study including 215 patients on hemodialysis between July 2012 and June 2014, censored until November 2015. MIS was used to assess patient's nutritional status at the moment they were enrolled in the study. They were followed for at least 18 months., Results: At the end of 18 months, 38 (17.7%) deaths, 20 renal transplants (9.3%), four facilities transference (1.9%), three dialysis method change (1.4%) and one renal function recovery (0.5%) were observed. One hundred seventy one patients completed at least 24 months of follow-up, and during this additional period, there were five deaths and one renal transplant more. Score higher than 7 points was able to predict mortality for both follow-up periods using sensitivity and specificity analysis and ROC curves. Using this cut-off on Kaplan-Meier survival curve, it was possible to confirm the association of MIS with all-cause mortality at 18 months and 24 or more months of follow-up. Finally, Cox multivariate analysis adjusted for demographic, clinical and nutritional variables showed MIS as the only significant predictor of mortality., Conclusion: MIS is an independent predictor of mortality in hemodialysis patients., (Copyright © 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Introduction: Protein–energy wasting (PEW) is very commonly seen among hemodialysis (HD) patients. This study was carried out to estimate the nutrition status of HD patients receiving aminase tablets, a proteolytic enzyme with a high-protein diet, for reducing PEW. Methods and Materials: The outpatients who visited the HD unit were nutritionally assessed using the Subjective Global Assessment (SGA). Malnourished patients were selected for the study. Diet advice was given on a high-protein diet as per the standard renal guidelines. They were nutritionally assessed pre- and postsupplementation at 0–6 months gap using SGA, malnutrition-inflammation score (MIS), bioelectrical impedance analysis, hand grip dynamometer, C-reactive protein (CRP), serum albumin, and total iron-binding capacity. Patients were given proteolytic enzyme 2 capsules daily after food (morning and night) for 6 months and high-protein diet. Results: A significant improvement (P < 0.05) was seen in the intracellular water, body cell mass, skeletal muscle mass, and protein mass. An improvement in the mean hand grip strength and mean reduction of CRP, SGA, and MIS scores were observed. Conclusion: Proteolytic enzyme along with a high-protein diet could be recommended for better clinical outcomes in dialysis patients. [ABSTRACT FROM AUTHOR]

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Background and Objective: Protein energy wasting (PEW) is a common syndrome in patients with chronic kidney disease, related to changes in hydration status, decreased food intake and inflammation. There are several tools for the assessment and diagnosis of such alterations. Bioimpedance vector analysis (BIVA) assess the state of nutrition and hydration, but not the inflammatory component, while the malnutrition inflammation score (MIS) comprises the inflammatory and nutritional factors, but not the state of hydration. The aim of the study was to determine the concordance between MIS and BIVA to assess nutritional status in peritoneal dialysis patients.Methods: We studied 50 patients on peritoneal dialysis which underwent  bioelectrical impedance measurements with an empty peritoneal cavity, also MIS was applied and biochemical parameters were evaluated.Results: The prevalence of malnutrition with VIBE and MIS was 38% and 24% respectively. Statistically significant differences in body mass index (BMI) and phase angle between normally nourished and wasted patients by both methods were found. Body composition, biochemical parameters and impedance vectors were not statistically different between normally nourished and wasted patients. Concordance between methods was 0.314 (p = 0.019).Conclusions: Combined nutritional assessment with MIS and BIVA is necessary for the diagnosis of protein energy wasting syndrome in patients undergoing peritoneal dialysis. [ABSTRACT FROM AUTHOR]

Background and Objectives: Malnutrition is highly prevalent in Malaysian dialysis patients and there is a need for a valid screening tool for early identification and management. This cross-sectional study aims to examine the sensitivity of the Dialysis Malnutrition Score (DMS) and Malnutrition Inflammation Score (MIS) tools in predicting protein-energy wasting (PEW) among Malaysian dialysis patients.Methods and Study Design: A total of 155 haemodialysis (HD) and 90 peritoneal dialysis (PD) patients were screened for risk of malnutrition using DMS and MIS and comparisons were made with established guidelines by International Society of Renal Nutrition and Metabolism (ISRNM) for PEW.Results: MIS cut-off score of >=5 indicated presence of malnutrition in all patients. A total of 59% of HD and 83% of PD patients had PEW by ISRNM criteria. Based on DMS, 73% of HD and 71% of PD patients exhibited moderate malnutrition, whilst using MIS, 88% and 90%, respectively were malnourished. DMS and MIS correlated significantly in HD (r2=0.552, p<0.001) and PD (r2=0.466, p<0.001) patients. DMS and MIS had higher sensitivity values in PD (81% and 82%, respectively) compared to HD (59% and 60%, respectively) patients.Conclusions: The MIS cut-off scores for malnutrition classification were established (score >=5) for use amongst Malaysian dialysis patients. Both DMS and MIS are valid tools to be used for nutrition screening of dialysis patients especially those undergoing peritoneal dialysis. The DMS may be a more practical and simpler tool to be utilized in the Malaysian dialysis settings as it does not require laboratory markers. [ABSTRACT FROM AUTHOR]