Malnutrition-Inflammation Score of Patients with Chronic Kidney Disease from Early Stage to Initiation of Dialysis

Abstract

Background: The malnutrition-inflammation score (MIS) is a practical and accessible tool for evaluating protein energy wasting (PEW) in patients on dialysis. However, the severity of PEW at each stage of chronic kidney disease (CKD), especially with late dialysis initiation, is unclear. Methods: We evaluated the MIS of 3659 patients with CKD stages 1-5 and the changes in their MIS results at baseline and at the time before dialysis initiation. Patients were defined to have PEW if they had a subjective global assessment (SGA) rating of C or lower. Results: The MIS increased substantially over a follow-up period of 6.12 years for 1124 patients just starting dialysis, with 49.3% having an MIS of 8. The pre-dialysis MIS was associated with baseline MIS, age, cardiovascular disease, and cancer. The prevalence of PEW based on an SGA rating of C or lower increased from 10.5% at baseline to 61.2% immediately before dialysis. The prevalence of PEW based on an MIS of ≥8 increased from 28.5% at baseline to 49.3% immediately before dialysis. In CKD stage 5 patients, 29.4% had PEW based on an MIS of 8 or less, and 11.6% had an SGA rating of C. The MIS was revealed to be associated with renal function, nutritional markers, and cardiometabolic disease (diabetes or cardiovascular disease). Conclusions: In conclusion, the MIS increased as CKD progressed to stages 4 and 5, as well as just prior to dialysis. Our study identified patients who required PEW assessment on the basis of their MIS results.

Keywords: chronic kidney disease (CKD); dialysis; malnutrition–inflammation score (MIS); nutritional assessment; protein energy wasting (PEW).

Figure 1

In patients without cardiometabolic disease, the percentage of MIS ≥ 8 was 4.0%, 9.7%, and 17.2% in CKD stages 3, 4, and 5, respectively. In patients with cardiometabolic disease, the percentage of MIS ≥ 8 was 12.0%, 22.2%, and 39.2% in CKD stages 3, 4, and 5, respectively.

Figure 2

There was a linear trend between the percentage of MIS ≥ 8 and albumin, hemoglobin, and C-reactive protein. There was a higher percentage of MIS ≥ 8 in the group of BMI 15–20 kg/m² compared with other groups.