Reliability of Mini Nutritional Assessment in Hemodialysis Compared With Subjective Global Assessment

Protein-energy malnutrition (PEM) is common in hemodialysis patients. Subjective Global Assesment (SGA) and Mini Nutritional Assessment (MNA) are two tools for monitoring PEM. Our aim was to determine reliability of MNA in detecting malnutrition in hemodialysis patients in comparison with SGA. The study population consisted of 137 patients with pure PEM with no signs of chronic inflammation. Nutritional statuses of patients were assessed concomitantly by SGA and MNA. Ninety-two patients were in SGA-A, 40 patients were in SGA-B, and 5 patients were in SGA-C. Forty-seven patients were in MNA-1, 77 patients were in MNA-2, and 13 patients were in MNA-3. Albumin (P = .0001), prealbumin (P = .0001), body mass index (P = .01), creatinine (P = .0001), and nPNA (P = .04) were statistically different between SGA groups. Creatinine (P = .001), blood urea nitrogen (P = .017), albumin (P = .001), prealbumin (P = .005), body mass index (P = .0001), and nPNA (P = .005) were statistically different between MNA groups. Fifty-two patients who had no evidence of malnutrition according to SGA were defined as having moderate malnutrition according to MNA. Seven patients who were in a state of moderate malnutrition determined by SGA were in good nutritional status according to MNA. SGA identified 8 patients as moderately malnourished; the same patients were defined as having severe malnutrition in MNA. Our results suggest that MNA might underestimate the nutritional status of hemodialysis patients who are not in an inflammatory state and may not be a reliable method for detecting moderate malnutrition when compared with SGA.