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Introduction: Asymmetric dimethylarginine (ADMA), a cardiovascular risk factor, increases in renal failure. The aim of this study was to investigate ADMA levels in normal weight and obese patients on hemodialysis. Methods: In this cross-sectional study, 43 normal weight and 43 obese patients on regular hemodialysis were examined. Malnutrition-inflammation score (MIS), anthropometry, circulating ADMA, lipid profiles including triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and lipid ratios, glucose homeostasis parameters, blood pressure, and high-sensitivity C-reactive protein (hs-CRP) were assessed. Results: Serum levels of ADMA were significantly lower in the obese compared to the normal weight patients (10268.2 ± 10092.4 vs. 13765.2 ± 9951.3 ng/l, P = 0.03). At the same time MIS score (6.1 ± 2.4 vs. 10.7 ± 3.2, P < 0.001), systolic blood pressure (119 ± 26.8 vs. 134.2 ± 24.7 mmHg, P = 0.018) and mean arterial pressure (91.3 ± 18.6 vs. 100.9 ± 15.9 mmHg, P = 0.028) were significantly lower in the obese than the normal weight group. Fasting blood glucose (P = 0.045), TG/HDL (P = 0.03), TC/HDL (P = 0.019), and LDL/HDL (P = 0.005) ratios, and hs-CRP (P = 0.015) levels were significantly higher in the obese than in the normal weight group. Conclusion: Circulating ADMA was significantly lower in obese than in normal weight patients on hemodialysis, which was concomitant with lower MIS, indicating a better nutritional inflammatory status, and lower blood pressure. [ABSTRACT FROM AUTHOR]

Abstract Introduction Asymmetric dimethylarginine (ADMA), a cardiovascular risk factor, increases in renal failure. The aim of this study was to investigate ADMA levels in normal weight and obese patients on hemodialysis. Methods In this cross-sectional study, 43 normal weight and 43 obese patients on regular hemodialysis were examined. Malnutrition-inflammation score (MIS), anthropometry, circulating ADMA, lipid profiles including triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and lipid ratios, glucose homeostasis parameters, blood pressure, and high-sensitivity C-reactive protein (hs-CRP) were assessed. Results Serum levels of ADMA were significantly lower in the obese compared to the normal weight patients (10268.2 ± 10092.4 vs. 13765.2 ± 9951.3 ng/l, P = 0.03). At the same time MIS score (6.1 ± 2.4 vs. 10.7 ± 3.2, P

Background: Malnutrition is a common complication of hemodialysis that needs to be prevented, properly diagnosed and treated. Intra-dialytic feeding is a controversial yet effective method to help < br />improve nutritional status. Objective(s): To assess intradialytic dietary pattern and nutritional status of hemodialysis patients and determine the energy and protein adequacy on hemodialysis and non-hemodialysis days. Methods: A cross sectional study was conducted using a predesigned interview questionnaire, 3-day 24-hour diet recall, anthropometric measurements, serum albumin and total iron binding capacity measurements, and malnutrition inflammation score (MIS) for 150 hemodialysis patients. Results: More than three quarters of the patients reported eating during the hemodialysis session with 71.3% of them eating due to the long session hours. Mean energy and protein intake on hemodialysis days was 1743.0 ± 718.1 kcal and 73.78 ± 37.15 g, respectively, which was significantly higher among patients who eat than those who don’t eat during the hemodialysis session (p < 0.001). Although mean serum albumin was higher in patients who eat during dialysis session and MIS was lower, there was no statistically significant difference between both groups. Conclusion: Intradialytic feeding is a common practice in chronic hemodialysis patients. Both energy and protein intakes and their adequacies were found to be higher in patients who eat during the dialysis session. This hints at the importance of utilization of dialysis session time to enhance the patients’ nutritional status. Therefore, it is recommended to individualize the advice of intradialytic feeding according to the patient’s needs.

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]

Background and aims: Screening malnutrition, which is the most common complication in hemodialysis patients, is extremely important for these patients. Malnutrition inflammation score (MIS) and geriatric nutritional risk index (GNRI) are malnutrition screening tests used in hemodialysis patients in recent years. The purposes of this study are to evaluate the nutritional status of hemodialysis patients with different screening tests and to determine the cutoff values for this disease‐specific MIS and GNRI. Methods: The study was conducted with 194 adult patients including 98 males and 96 females whose mean age was 53.1 ± 10.96. Subjective global assessment (SGA) and MIS tests were applied, and the GNRI value was calculated for screening malnutrition. MIS and GNRI cutoff values were obtained by adopting the SGA scores as a standard and drawing a receiver operating characteristic curve. The tatistical Package for the Social Sciences‐22.0 package program was used in the analysis. Results: According to SGA, 70.7% of the patients were nourished, 21.1% were mildly‐moderately malnourished, and 8.2% were found to be severely malnourished. The optimal cutoff value predicted for malnutrition was 6.5 points (94.7% sensitivity and 98.5% specificity) for MIS and 86.0 points (64.9% sensitivity and 62.8% specificity) for GNRI. Based on these cutoff values, 28.9% of the patients were determined to be malnourished according to MIS and 45.4% according to GNRI. Conclusion: In conclusion, screening tests are very important in the early identification of malnutrition in hemodialysis patients. This study was conducted to evaluate the malnutrition of hemodialysis patients with different screening tests. At the end of the study, the availability of MIS was found to be high in detecting malnutrition in hemodialysis patients because of its high accuracy and sensitivity of MIS. The cutoff points we identified for both MIS and GNRI are thought to facilitate the determination of malnutrition. [ABSTRACT FROM AUTHOR]

Protein-energy wasting (PEW) is considered one of the major complications of chronic kidney disease (CKD), particularly in dialysis patients. Insufficient energy and protein intake, together with clinical complications, may contribute to the onset and severity of PEW. Therefore, the aim of the study was to analyze the differences in nutritional and hydration status and dietary intake among Dalmatian dialysis patients. Fifty-five hemodialysis (HD) and twenty peritoneal dialysis (PD) participants were included. For each study participant, data about body composition, anthropometric, laboratory, and clinical parameters were obtained. The Malnutrition Inflammation Score (MIS) and two separate 24-h dietary recalls were used to assess nutritional status and dietary intake. The Nutrient Adequacy Ratio (NAR) and Mean Adequacy Ratio (MAR) were calculated to compare actual dietary intake with recommended intake. Additionally, the estimated 10-year survival was calculated using the Charlson Comorbidity Index. The prevalence of malnutrition according to MIS was 47.3% in HD and 45% in PD participants. Significant differences in fat tissue parameters were found between HD and PD participants, whereas significant differences in hydration status and muscle mass parameters were not found. A significant difference in NAR between HD and PD participants was noticed for potassium and phosphorus intake, but not for MAR. MIS correlated negatively with anthropometric parameters, fat mass, visceral fat level and trunk fat mass, and iron and uric acid in HD participants, whereas no significant correlations were found in PD participants. The estimated 10-year survival correlated with several parameters of nutritional status in HD and PD participants, as well as nutrient intake in HD participants. These results indicate a high prevalence of malnutrition and inadequate dietary intake in the Dalmatian dialysis population which, furthermore, highlights the urgent need for individualized and structural nutritional support. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic kidney disease have muscle wasting, sarcopenia, and cachexia that contribute to frailty and morbidity. The present study assessed the prevalence of protein-energy wasting in dialysis-dependent chronic kidney disease population and evaluated the validity of various nutritional assessment tools in diagnosing protein-energy wasting., Materials and Methods: All patients above 18 years undergoing dialysis for more than 3 months without any active infection or malignancy were included in our study. Data from anthropometric measurements, dietary assessment, and blood investigations were collected. Protein-energy wasting was assessed by the International Society of Renal Nutrition and Metabolism 2008 criteria. Diagnostic validity of the nutritional assessment tools to predict protein-energy wasting was estimated by area under the curve, sensitivity, specificity, and accuracy statistics., Results: A total of 146 patients were studied. The prevalence of protein-energy wasting was 56.8%. Protein-energy wasting was significantly associated with socioeconomic status, hospitalization days, and catheter days. Normalized protein catabolism rate had the highest sensitivity (90.4%) for predicting protein-energy wasting. Malnutritional inflammatory score had the highest area under the curve (0.858), specificity (82.5%), and accuracy (82.2%). Mid-upper arm circumference, Dialysis Malnutrition Score, and albumin were also found to be significant predictors of protein-energy wasting., Conclusion: Lack of advanced equipment in suburban and rural centers to detect protein-energy wasting in India can be overcome by using the various stand-alone and combination nutrition assessment tools which have been validated in the present study., Competing Interests: There are no conflicts of interest., (© 2024 Indian Journal of Nephrology | Published by Scientific Scholar.)

This cross-sectional study aims to explore the prevalence of protein-energy wasting (PEW) in dialysis patients in Catalonia, Spain, using a new and practical online tool which enables rapid calculation and comparison with other nutritional scores. Methods: A web tool (Nutrendial) was created to introduce different variables and automatically calculate PEW, Malnutrition inflammation Score (MIS) and Subjective Global Assessment (SGA) in 1389 patients (88% in haemodialysis (HD)), 12% in peritoneal dialysis (PD) from different regions of Catalonia. Results: A prevalence of 23.3% (26% HD, 10.2% PD) of PEW was found, with a mean MIS score of 6 and SGA score of C in 7% of the patients. ROC analysis showed MIS as the best nutritional score to diagnose PEW (AUC 0.85). Albumin delivered lower diagnostic precision (AUC 0.77) and sensitivity (66%). A cut off point of 7 (86% sensitivity and 75% specificity) for MIS and 3.7 mg/dL for albumin were found to predict the appearance of PEW in this population. SGA B or C showed an 87% sensitivity and 55% specificity to diagnose PEW. Very low nutritional intervention (14%) was recorded with this tool in patients with PEW. Conclusions: This new online tool facilitated the calculation of PEW, enabling different professionals—including nephrologists, dieticians and nurses—to efficiently obtain insights into the nutritional status of the Catalonian dialysis population and implement the required nutritional interventions. MIS is the score with more sensitivity to diagnose PEW. [ABSTRACT FROM AUTHOR]

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This cross-sectional study aims to explore the prevalence of protein-energy wasting (PEW) in dialysis patients in Catalonia, Spain, using a new and practical online tool which enables rapid calculation and comparison with other nutritional scores. Methods: A web tool (Nutrendial) was created to introduce different variables and automatically calculate PEW, Malnutrition inflammation Score (MIS) and Subjective Global Assessment (SGA) in 1389 patients (88% in haemodialysis (HD)), 12% in peritoneal dialysis (PD) from different regions of Catalonia. Results: A prevalence of 23.3% (26% HD, 10.2% PD) of PEW was found, with a mean MIS score of 6 and SGA score of C in 7% of the patients. ROC analysis showed MIS as the best nutritional score to diagnose PEW (AUC 0.85). Albumin delivered lower diagnostic precision (AUC 0.77) and sensitivity (66%). A cut off point of 7 (86% sensitivity and 75% specificity) for MIS and 3.7 mg/dL for albumin were found to predict the appearance of PEW in this population. SGA B or C showed an 87% sensitivity and 55% specificity to diagnose PEW. Very low nutritional intervention (14%) was recorded with this tool in patients with PEW. Conclusions: This new online tool facilitated the calculation of PEW, enabling different professionals—including nephrologists, dieticians and nurses—to efficiently obtain insights into the nutritional status of the Catalonian dialysis population and implement the required nutritional interventions. MIS is the score with more sensitivity to diagnose PEW.

This article discusses the importance of nutrition intervention and management in clinical dietetic practice with the aid of nutrition care process (NCP) in a Stage 5 chronic renal failure, hypertensive outdoor patient. The objective was to provide medical nutrition therapy to the patient to delay the progression of the disease and improve the quality of life. Patient education was emphasized during every diet counseling session. The patient progressed through nutrition care as indicated in the plan of care, with improvement. NCP was used to document and manage nutrition care and involves four steps: nutrition assessment and reassessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring and evaluation. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) is a progressive disease that leads to end-stage renal disease (ESRD). Malnutrition increases the risk of mortality among patients with ESRD. This study aimed to determine malnutrition prevalence and associated factors among twice-weekly (n = 94/120) and thrice-weekly (n = 26/120) hemodialysis patients/HDP., Method: A cross-sectional study was conducted at two tertiary-level public hospitals in Dhaka city using a consecutive sampling technique from April to June 2021. Nutritional status was assessed by Malnutrition Inflammation Score (MIS). Multivariable ordinal logistic regression was performed to determine which socioeconomic, clinical, anthropometric, biochemical, and dietary factors are associated with MIS., Results: The prevalence of malnutrition was very high among HDP (severe 15.5%, mild/moderate 56.7%) with an average dialysis vintage of 28.7 months. Comorbidities (80.8%) and gastrointestinal symptoms/GIS (68.3%) were ubiquitous, and "dialysis frequencies" were not associated with MIS in bivariate analysis. Multivariable ordinal regression showed that anthropometric factors like mid-upper arm circumference/MUAC (adjusted odds ratio/AOR = 0.978), post-dialysis body mass index/BMI (AOR = 0.957), and biochemical parameters like albumin (AOR = 0.733) and TIBC/total iron binding capacity (AOR = 0.996) negatively ( P < .05) associated with MIS. Moreover, having "no GIS" (AOR = 0.672, P < .001) was 33.0% less likely to be associated with MIS. Contrarily, as the month of dialysis increases, MIS increases by 22.0% (AOR = 1.22)., Conclusion: Significant associations of clinical, anthropometric, and biochemical characteristics with MIS indicate the importance of routine screening of the nutritional status of patients with CKD to improve health status and prevent protein-energy wasting. The MIS could be a simple, noninvasive tool for testing nutritional status in patients with CKD., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of PBJ-Associação Porto Biomedical/Porto Biomedical Society.)

Objective: Hemodialysis patients may be at risk for malnutrition due to catabolic effects caused by dialysis, loss of amino acids, inadequate nutrient intake, acidosis, and inflammation. Malnutrition may have negative effects on quality of life, mortality, and disease prognosis. This study was conducted to determine the relationship between anthropometric parameters, depression, and quality of life with Malnutrition Inflammation Score (MIS) on 55 patients aged between 18 and 65 years (36 males and 19 females) who have dialysis treatment for 3 days per week for at least 3 months due to end-stage renal disease. Methods: Patients were evaluated with MIS, Subjective Global Assessment (SGA), Beck Depression Inventory (BDI), and Satisfaction with Life Scale (SWLS). In addition, anthropometric (body weight, height, mid-upper arm circumference [MUAC]) and body composition measurements of patients were taken, body mass index (BMI) values were calculated, and biochemical parameters (albumin, C-reactive protein [CRP], and total iron binding capacity [TIBC]) were analyzed. Results: At the end of the study, 14.5% of the patients according to SGA, were classified as malnourished. There was a statistically significant positive correlation of BDI, duration of dialysis, and CRP with MIS. However, MIS had a statistically significant negative correlation with SWLS, body weight, and MUAC (p < 0.05). Conclusion: MIS is an effective screening tool for assessing malnutrition and quality of life in hemodialysis patients. However, there is a need for studies to identify cutoff points of MIS. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Summary 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. [ABSTRACT FROM AUTHOR]

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]

Aim Protein-energy wasting ( PEW) is prevalent in haemodialysis. Obesity is an independent risk factor of kidney insufficiency, but it is proposed to have beneficial roles in better outcomes in the final stage of disease. Better nutritional status and body reserves are among probable mechanisms, but direct examinations are limited. The present study aimed to investigate whether obese patients have preferable nutritional status compared to normal weight patients based on malnutrition inflammation score ( MIS) and other PEW parameters in haemodialysis. Methods This case-control study investigated 52 normal weight (18.5 < body mass index ( BMI) < 25 kg/m2) and 48 obese ( BMI≥30 kg/m2) patients on regular haemodialysis. PEW was assessed based on anthropometric and biochemical factors, recent weight changes, appetite, anorexia, dietary intake and MIS. Results Obese patients had better MIS compared with the normal weight group ( P < 0.001), although varying degrees of wasting were prevalent among this group too (75% mild and 25% moderate wasting). The obese group had less significant weight loss (4.2 vs 8%) and anorexia and better appetite. However, a considerable percentage of patients in both groups showed muscle (94.6% of normal weight and 19.5% of obese) and peripheral fat tissue (89.2% of normal weight and 31.7% of obese) losses compared to the 50th percentile. Biochemical parameters were not significantly different between groups except for triglyceride ( P = 0.001), transferrin and total iron-binding capacity ( P = 0.028). Conclusions MIS was significantly better in obese patients; however, both groups showed degrees of wasting based on MIS and other PEW parameters. Nutritional status of obese haemodialysis patients should be monitored regularly because of high risk of PEW like other BMI categories. [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]

Purpose: The present study was designed to determine the cutoff points for the diagnosis of mild-to-moderate and severe protein-energy wasting (PEW) based on dialysis malnutrition score (DMS) and malnutrition inflammation score (MIS), and the sensitivity, specificity, accuracy, area under receiver operating characteristic (ROC) curve, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR) and negative likelihood ratio (LR) of DMS and MIS in comparison with subjective global assessment (SGA) in hemodialysis (HD) patients. Methods: In this study, 291 HD patients were randomly selected from among 2,302 adult HD patients in Tehran hemodialysis centers. The PEW in these patients was determined by SGA, DMS and MIS. Results: According to the cutoff points derived from the area under ROC curves, scores of 7-13 for DMS represented normal status or without PEW; 14-23, mild-to-moderate PEW; and 24-35, severe PEW. For MIS, scores of 0-7 represented normal status or without PEW; 8-18, mild-to-moderate PEW; and 19-30, severe PEW. In comparison with SGA, the sensitivity, specificity, accuracy, area under ROC curve, PPV, NPV, LR and LR of DMS were 94 %, 88 %, 92 %, 97 %, 93 %, 92 %, 7.8 and 0.07, respectively. Those of MIS were 87 %, 96 %, 91 %, 97 %, 97 %, 83 %, 22.0 and 0.13 in comparison with SGA, respectively. Conclusion: The results of the present study indicate that the DMS and MIS are almost similar to SGA for identifying PEW in HD patients, but it seems that the DMS is a more appropriate alternative tool for SGA in hospital routine assessments. [ABSTRACT FROM AUTHOR]

Objective:Hepatitis C virus (HCV) infection exerts diverse effects on atherogenesis. We investigated whether malnutrition inflammation score (MIS) is associated with the presence of coronary artery disease (CAD) in anti-HCV-positive hemodialysis (HD) patients.Subjects/Methods:Twenty-two anti-HCV-positive HD patients with CAD and 61 anti-HCV-positive HD patients without CAD (as controls) were included. Data were obtained from hospital records, patients were evaluated for risk factors for CAD. The same physician performed MIS evaluation.Results:MIS of anti-HCV-positive HD patients with CAD were significantly higher than patients without CAD (8.8±4.0 vs 6.5±2.6, P=0.02). In patients with CAD, basal (P=0.002) and peak C-reactive protein (P=0.03) and serum ferritin (P=0.01) concentrations were higher, serum albumin concentrations (P=0.003) were lower than those patients without CAD. MIS was positively correlated with age (r=+0.359, P=0.001) and viral load (r=+0.629, P<0.0001). In univariate logistic regression analysis, advanced age (odds ratios (OR)=1.093, confidence interval (CI): 1.039–1.150, P=0.001), hypertension (OR=3.143, CI: 1.084–9.116, P=0.035), diabetes mellitus (OR=5.344, CI: 1.343–21.269, P=0.017), low triglyceride (OR=0.992, CI: 0.984–0.999, P=0.026) and high MIS (OR=1.259, CI: 1.066–1.488, P=0.007) were associated with the presence of CAD. Multivariate logistic regression analysis identified age (OR=1.090, CI: 1.007–1.179, P=0.033) and MIS as the factors associated with the presence of CAD (OR=1.232, CI: 1.004–1.511, P=0.04).Conclusions:MIS may be associated with CAD in anti-HCV-positive HD patients.European Journal of Clinical Nutrition (2008) 62, 1449–1454; doi:10.1038/sj.ejcn.1602867; published online 1 August 2007 [ABSTRACT FROM AUTHOR]

Objective: Better nutritional reserves are proposed as a mechanism for the protective role of obesity in hemodialysis. Little is known about the quality of diet as a major contributor to nutritional status, specifically body mass index and obesity. The aim of this study was to assess dietary inflammatory index (DII®) score and other parameters of diet in normal-weight and obese patients undergoing hemodialysis to understand whether there is a benefit for obese patients., Methods: This cross-sectional study included 85 hemodialysis patients (44 obese and 41 normal-weight). Four-day 24-h dietary recalls and anthropometric measurements were collected. DII, energy-adjusted DII (E-DII), dietary energy density (DED), mean adequacy ratio (MAR), and malnutrition inflammation score (MIS) were calculated., Results: Median E-DII score (1 [0.29-1.47] versus 0.42 [0.12-1.27]; P = 0.047) was higher and DII score (1.18 [0.03-2.26] versus 1.79 [0.47-2.49]; P = 0.046) was lower in the obese group. Obese patients had higher DED (1.52 ± 0.23 versus 1.43 ± 0.28; P = 0.034) and lower MIS (6.3 ± 2.5 versus 10.5 ± 3.1; P < 0.001) compared with the normal weight group. There was no significant difference in MAR between groups (P = 0.358). E-DII had significant positive correlation with weight (r = 0.226; P = 0.037), triceps skinfold thickness (r = 0.239; P = 0.035), and DED (r = 0.227; P = 0.036). MAR had significant negative correlation with MIS (r = -0.287; P = 0.008)., Conclusions: Observed higher diet inflammatory potential and energy density and lower wasting in the obese group, along with similar adequacy of nutrients intake between groups, indicates that lower wasting, but not other indicators of nutritional status, are involved in better prognosis of obese patients with hemodialysis. Further studies are required to assess the potential dietary factors involved in determining wasting in advanced kidney failure., (Copyright © 2018 Elsevier Ltd. 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.)

Background/Aims: A high peritoneal membrane transport status and peritoneal albumin leakage are determinants of morbidity and mortality in patients receiving continuous ambulatory peritoneal dialysis. In this study, we analyzed the relationship between the malnutrition inflammation score, peritoneal transport status, and 24-hour peritoneal albumin leakage in patients receiving peritoneal dialysis. Methods: Sixty-six patients receiving peritoneal dialysis (male-female ratio 30/36; age 46.2 ± 14.1 years; mean duration of peritoneal dialysis 32.4 ± 23.9 months) who had experienced no attacks of peritonitis within the prior 6 months were included. Results: The malnutrition inflammation score was positively correlated with the serum C-reactive protein concentration, dialysate/plasma creatinine ratio, and 24-hour peritoneal albumin leakage. Triceps and biceps skinfold thicknesses and serum concentrations of prealbumin, total cholesterol, and triglyceride were negatively correlated with the malnutrition inflammation score. Multiple linear regression analysis showed that the malnutrition inflammation score was independently associated with the dialysate/plasma creatinine ratio (p = 0.039) and 24-hour peritoneal albumin amount (p = 0.005). Conclusion: High peritoneal transport status and peritoneal albumin leakage are significantly associated with the malnutrition inflammation score. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]