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.
If the inline PDF is not rendering correctly, you can download the PDF file here.
1. Coresh J Astor BC Greene T Eknoyan G Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult U.S. population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 2003; 41: 1–12.
2. 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 Int 2008; 73: 391–8.
3. Carrero JJ Stenvinkel P Cuppari L Ikizler TA Kalantar-Zadeh K Kaysen G et al. Etiology of the protein-energy wasting syndrome in chronic kidney disease: a consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM). J RenNutr 2013; 23: 77–90.
4. Kopple JD. MaCollum award lecture PEM in maintainence dialysis patients. Am J ClinNutr 1996; 65: 1544–57.
5. D Sen J Prakash. Nutrition in Dialysis patients. J Assoc Physician India 2000; 48: 724–30.
6. Pupim LB Cuppari L Ikizler TA. Nutrition and metabolism in kidney disease. Semin Nephrol 2006; 26: 134–57.
7. Baker JP Detsky AS Wesson DE Wolman SL Stewart S Whitewell J et al. Nutritional assessment: a comparison of clinical judgement and objective measurements. N Engl J Med 1982; 306: 969–72.
8. Kalantar-Zadeh K Kopple JD Block G. A malnutrition inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. Am J Kidney Dis 2001; 38: 1251–63.
9. Tonelli M Sacks F Pfeffer M Jhangri GS Curhan G: Biomarkers of inflammation and progression of chronic kidney disease. Kidney Int 2005; 68: 237–45.
10. Kopple JD: Nutritional status as a predictor of morbidity and mortality in maintenance dialysis patients. ASAIO J1997; 43: 246–50.
11. Singh T Sharma S Nagesh S. Socio-economic status scales updated for 2017.Int J Res Med Sci 2017; 5(7): 3264–7.
12. González-Ortiz AJ Arce-Santander CV Vega-Vega O Correa-Rotter R Espinosa-Cuevas Mde L. Assessment of the reliability and consistency of the “malnutrition inflammation score” (MIS) in Mexican adults with chronic kidney disease for diagnosis of protein-energy wasting syndrome (PEW). Nutr Hosp 2014; 31(3): 1352–8.
13. Kalantar-Zadeh K Ikizler TA Block G Avram MM Kopple JD. Malnutrition-inflammation complex syndrome in dialysis patients: causes and consequences. Am J Kidney Dis 2003; 42(5): 864–81.
14. Kir HM Eraldemir C Dervisoglu E Caglayan C Kalender B. Effects of chronic kidney disease and type of dialysis on serum levels of adiponectin TNF-alpha and high sensitive C-reactive protein. Clin Lab 2012; 58: 495–500.
15. Lawson JA Lazarus R Kelly JJ. Prevalence and prognostic significance of malnutrition in chronic renal insufficiency. J RenNutr 2001; 11: 16–22.
16. Prakash J Raja R Mishra RN Vohra R Sharma N Wani IA et al. High prevalence of malnutrition and inflammation in undialyzed patients with chronic renal failure in developing countries: A single center experience from eastern India. Renal Failure 2007; 29: 811–6.
17. Ebrahimzadehkor B Dorri A Gharavi AY. Malnutrition inflammation score in hemodialysis patient. Zahedan J Res Med Sci 2014; 16(8): 25–8.
18. Amparo FC Kamimura MA Molnar MZ Cuppari L Lindholm B Amodeo C et al. Diagnostic validation and prognostic significance of the Malnutrition-Inflammation Score in nondialyzed chronic kidney disease patients. Nephrol Dial Transplant 2015; 30(5): 821–8.
19. Garg AX Blake PG Clark WFClase CM Haynes RB Moist LM. Association between renal insufficiency and malnutrition in older adults: Results from the NHANES III. Kidney Int 2001; 60(5): 1867–74.
20. Ho LC Wang HH Chiang CK Hung KY Wu KD. Malnutrition-inflammation score independently determined cardiovascular and infection risk in peritoneal dialysis patients. Blood Purif 2010; 29(3): 308–16.
21. Stevinkel P Alvestrand D. Inflammation in end-stage renal disease: Sources consequences and therapy. Semin Dial 2002; 15(5): 329–37.
22. Kalantar-Zadeh K Don BR Rodriguez RA Humphreys MH. Serum ferritin is a marker of morbidity and mortality in hemodialysis patients. Am J Kidney Dis 2001; 37: 564–72.
23. Kalantar-Zadeh K McAllister C Lehn R Lee G Nissenson A Kopple J. Effect of malnutrition–inflammation complex syndrome on erythropoietin hyporesponsiveness in maintenance hemodialysis patients. Am J Kidney Dis 2003;42(4): 761–73.
24. Christian Wilde. Hidden Causes of Heart Attack and Stroke: Inflammation Cardiology’s New Frontier. Abigon Press 2003; 182–3.
25. Kanwar M Hashem M Rosman H Kamalakannan D Cheema A Ali A et al. Usefulness of clinical evaluation troponins and C-reactive protein in predicting mortality among stable hemodialysis patients. Am J Cardiol 2006; 98: 1283–7.