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Multicenter Study
. 2020 Mar 4;15(3):e0229722.
doi: 10.1371/journal.pone.0229722. eCollection 2020.

The screening score of Mini Nutritional Assessment (MNA) is a useful routine screening tool for malnutrition risk in patients on maintenance dialysis

Els Holvoet  1 , Karsten Vanden Wyngaert  2 , Amaryllis H Van Craenenbroeck  3   4 , Wim Van Biesen  1 , Sunny Eloot  1
Affiliations
Multicenter Study

The screening score of Mini Nutritional Assessment (MNA) is a useful routine screening tool for malnutrition risk in patients on maintenance dialysis

Els Holvoet et al. PLoS One. .

Abstract

Purpose: Malnutrition is prevalent in patients on dialysis and is associated with morbidity and mortality. Nutritional status can be assessed by a variety of biochemical and physical parameters or nutritional assessment scores. Most of these methods are expensive or cumbersome to use and are not suitable for routine repetitive follow-up in dialysis patients. The Mini Nutritional Assessment (MNA) has a short form screening set (MNA-SF), which would be suitable as a screening tool, but has not been validated yet in dialysis patients. We aimed to assess whether the MNA is an appropriate tool for identifying nutritional problems in dialysis patients.

Method: MNA, routine biochemistry, physical parameters, comorbidities were assessed in cross-sectional multicentric cohorts of hemodialysis and peritoneal dialysis patients with a longitudinal follow up of 2 years for mortality.

Results: In this cohort of 216 patients, mortality was 27.3% at a follow up of 750±350 days. The mean MNA-SF score was 9.9±1.8, with 30.1%, 59.3% and 10.6% of patients categorized as having normal nutritional status, at risk for malnutrition and malnourished, respectively. The screening score was associated with mortality (HR 0.86, 95% CI 0.75-0.98 per point). With normal nutrition as reference, adjusted mortality was 2.50 (95% CI 1.16-5.37) and 3.89 (95% CI 1.48-10.13) for patients at risk for malnutrition and with malnutrition, respectively. After recalibrating the MNA full score for the specificity of some of its domains for dialysis patients, the MNA-SF had a good sensitivity and specificity for not being well nourished (0.95 and 0.63 respectively) in the full score, and a high negative predictive value (0.91).

Conclusion: The MNA-SF is independently associated with 2 year mortality in dialysis patients. It has a high negative predictive value for excluding being at risk or having malnutrition in the full score. Therefore, it can be advocated as a screening tool for nutritional status in dialysis patients.

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Conflict of interest statement

The authors have declared that no competing interests exists.

Figures

Fig 1
Fig 1
(A) Categorization according to the standardized MNA-SF score. (B) Categorization according to the standardized MNA-LF score. (C) Categorization according to the MNA-LF-new score. (D) Categorization according to the MNA-LF-ESKD score.
Fig 2
Fig 2. ROC curve for the MNA-LF using dichotomized MNA-SF (normal nutritional status versus at risk/malnourished) as referent.
Fig 3
Fig 3
(A) Re-categorization between MNA-SF and MNA-LF. (B) Re-categorization between MNA-SF and MNA-LF-new. (C) Re-categorization between MNA-SF and MNA-LF-ESKD.
Fig 4
Fig 4. Survival in function of MNA-SF score, adjusted for age, gender and Davies Stoke Score.
See this image and copyright information in PMC

References

    1. Bilgic A, Akgul A, Sezer S, Arat Z, Ozdemir FN, Haberal M. Nutritional status and depression, sleep disorder, and quality of life in hemodialysis patients. Journal of renal nutrition: the official journal of the Council on Renal Nutrition of the National Kidney Foundation. 2007;17(6):381–8. Epub 2007/11/01. 10.1053/j.jrn.2007.08.008 . - DOI - PubMed
    1. Kwon YE, Kee YK, Yoon CY, Han IM, Han SG, Park KS, et al. Change of Nutritional Status Assessed Using Subjective Global Assessment Is Associated With All-Cause Mortality in Incident Dialysis Patients. Medicine. 2016;95(7):e2714 Epub 2016/02/18. 10.1097/MD.0000000000002714 - DOI - PMC - PubMed
    1. Laws RA, Tapsell LC, Kelly J. Nutritional status and its relationship to quality of life in a sample of chronic hemodialysis patients. Journal of renal nutrition: the official journal of the Council on Renal Nutrition of the National Kidney Foundation. 2000;10(3):139–47. Epub 2000/08/02. 10.1053/jren.2000.7412 . - DOI - PubMed
    1. Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney international. 2008;73(4):391–8. Epub 2007/12/21. 10.1038/sj.ki.5002585 - DOI - PubMed
    1. Piccoli GB, Moio MR, Fois A, Sofronie A, Gendrot L, Cabiddu G, et al. The Diet and Haemodialysis Dyad: Three Eras, Four Open Questions and Four Paradoxes. A Narrative Review, Towards a Personalized, Patient-Centered Approach. Nutrients. 2017;9(4). Epub 2017/04/11. 10.3390/nu9040372 - DOI - PMC - PubMed

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