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Differences in Malnutrition Inflammation Score of Hemodialysis Patients Associated With Hemodialysis Factors. A Spanish Multicenter Epidemiologic Study

Published:March 30, 2022DOI:https://doi.org/10.1053/j.jrn.2022.03.006

      Objectives

      The aims of this study are to analyze the prevalence of malnutrition in hemodialysis (HD) patients in Spain, and to assess the association of malnutrition in these patients with sociodemographic characteristics, comorbidity, and parameters related to HD.

      Design and Methods

      A multicenter, retrospective, cross-sectional study in HD patients from centers all over Spain was conducted. Nutritional status of patients was assessed using Malnutrition Inflammation Score (MIS), and was stratified according to MIS values into 5 categories: ≤2, normal nutrition; >2 to ≤5, mild malnutrition or risk of malnutrition; >5 to ≤7, moderate malnutrition; >7 to ≤10, severe malnutrition, and >10, extreme malnutrition.

      Results

      A total of 52 Spanish HD Units participated in the study enrolling 2,748 patients. Mean age of patients was 68.20 ± 14.24 years, 1,811 (65.9%) were men. Mean time on HD was 55.63 ± 63.25 months. Using an MIS cut-off point of 2 for malnutrition, 89% of patients were malnourished (MIS > 2). However, with a cut-off point of 5, more commonly described in the literature, the percentage of patients with malnutrition was reduced to 51.7%. Using this cut-off, we observed significant differences between patients with malnutrition and normo-nourished patients in biochemical parameters, age, Charlson Index, HD residual renal function, scheme, and vascular access (permanent catheter vs arteriovenous fistula). A multivariate regression analysis showed that age, sex, HD scheme, vascular access, residual renal function, and comorbidity index were predictive factors for malnutrition. We found that a high percentage of HD patients with malnutrition did not receive oral supplementation.

      Conclusions

      The prevalence of malnutrition in HD patients in Spain, assessed using the MIS scale, was high. Higher malnutrition was associated with the use of catheter versus fistula, and standard HD versus online hemodiafiltration, and with the absence of residual renal function, older age, greater comorbidity, and male sex. Malnourished patients had a low rate of oral supplementation.

      Keywords

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      References

        • Hakim R.M.
        • Levin N.
        Malnutrition in haemodialysis patients.
        Am J Kidney Dis. 1993; 21: 125-137
        • Sahathevan S.
        • Khor B.H.
        • Ng H.M.
        • et al.
        Understanding development of malnutrition in hemodialysis patients: a Narrative review.
        Nutrients. 2020; 12: 3147
        • Kalantar-Zadeh K.
        • Block G.
        • McAllister C.J.
        • et al.
        Appetite and inflammation, nutrition, anemia, and clinical outcome in hemodialysis patients.
        Am J Clin Nutr. 2004; 80: 299-307
        • Kalantar-Zadeh K.
        • Kopple J.D.
        • Humphreys M.H.
        • Block G.
        Comparing outcome predictability of markers of malnutrition-inflammation complex syndrome in haemodialysis patients.
        Nephrol Dial Transpl. 2004; 19: 1507-1519
        • Sabatino A.
        • Regolisti G.
        • Karupaiah T.
        • et al.
        Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on hemodialysis.
        Clin Nutr. 2017; 36: 663-671
        • Pablo A.M.
        • Izaga M.A.
        • Alday L.A.
        Assessment of nutritional status on hospital admission: nutritional scores.
        Eur J Clin Nutr. 2003; 57: 824-831
        • Edalat-Nejad M.
        • Zameni F.
        • Qlich-Khani M.
        • Salehi F.
        Geriatric nutritional risk index: a mortality predictor in haemodialysis patients.
        Saudi J Kidney Dis Transpl. 2015; 26: 302-308
        • Kalantar-Zadeh K.
        • Kleiner M.
        • Dunne E.
        • Lee G.H.
        • Luft F.C.
        A modified quantitative subjective global assessment of nutrition for dialysis patients.
        Nephrol Dial Transpl. 1999; 14: 1732-1738
        • Fouque D.
        • Kalantar-Zadeh K.
        • Kopple J.
        • et al.
        A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease.
        Kidney Int. 2008; 74: 393
        • Barbosa-Silva M.C.
        Subjective and objective nutritional assessment methods: what do they really assess?.
        Curr Opin Clin Nutr Metab Care. 2008; 11: 248-254
        • Hanafusa N.
        • Tsuchiya K.
        • Nitta K.
        Malnutrition-wasting conditions in older dialysis patients: an Individualized Approach.
        Contrib Nephrol. 2019; 198: 12-20
        • Fiedler R.
        • Jehle P.M.
        • Osten B.
        • Dorligschaw O.
        • Girndt M.
        Clin. Nutr scores are superior for the prognosis of haemodialysis patients compared to lab markers and bioelectrical impedance.
        Nephrol Dial Transpl. 2009; 24: 3812
        • Kalantar-Zadeh K.
        • Kopple J.D.
        • Block G.
        • Humphreys M.H.
        A malnutrition- inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients.
        Am J Kidney Dis. 2001; 38: 1251-1263
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 36: 373-383
        • Jankowska M.
        • Cobo G.
        • Lindholm B.
        • Stenvinkel P.
        Inflammation and protein- energy wasting in the uremic Milieu.
        Contrib Nephrol. 2017; 191: 58-71
        • Alvarenga L.A.
        • Andrade B.D.
        • Moreira M.A.
        • Nascimento R.P.
        • Macedo I.D.
        • Aguiar A.S.
        Perfil nutricional de los pacientes con hemodiálisis con respecto al tiempo de tratamiento.
        J Bras Nefrol. 2017; 39: 283-286
        • Islam A.
        Hassanin HazemHassanein PilarElmenshawy 1DinaEl-Gameel Aya, A. Elsheikh AyaEl-Kobrosly 1BajoSamir RafaelEmil MerihanAlaa Dina H. Selim. Herramientas de detección nutricional para pacientes con hemodiálisis.
        Clinical Nutrition ESPEN. 2021;
        • Kalantar-Zadeh K.
        • Kleiner M.
        • Dunne E.
        • Nelson M.
        • Ahern K.
        • Koslowe R.
        • Luft F.C.
        Total iron binding capacity- estimated transferrin concentrations in dialysis patients correlate with the assessed repeatedly by any member of the dialysis care subjective global assessment of nutrition.
        Am J Kidney Dis. 1998; 31: 263-272
        • Peter S.
        • Heimburger O.
        • Paultre F.
        • et al.
        Fuerte asociación entre la desnutrición, la inflamación,y aterosclerosis en insuficiencia renal crónica.
        Kid Intern. 1999; 55: 1899-1911
        • Martins V.Sá
        • Aguiar L.
        • Dias C.
        • et al.
        Predictors of nutritional and inflammation risk in hemodialysis patients.
        Clin Nutr. 2020; 39: 1878-1884
        • As’habi A.
        • Tabibi H.
        • Hedayati M.
        • Mahdavi-Mazdeh M.
        • Nozary-Heshmati B.
        Association of malnutrition-inflammation score, dialysis-malnutrition score and serum albumin with novel risk factors for cardiovascular diseases in hemodialysis patients.
        Ren Fail. 2015; 37: 113-116
        • Tiranathanagul K.
        • Praditpornsilpa K.
        • Katavetin P.
        • et al.
        On-line hemodiafiltration in Southeast Asia: a Three-year Prospective study of a Single center.
        Ther Apher Dial. 2009; 13: 56-62
        • Sabica V.
        • Ciolino F.
        • Monando P.
        • et al.
        Nutritional status in hemodialysis patients: Options for online convective treatment.
        J Ren Nutr Vol. 2006; 16: 237-240
        • Zhang Z.-Y.
        • Li M.-X.
        • Yu H.
        • et al.
        Combination of multiple hemodialysis Modes: Better treatment Options for patients under maintenance hemodialysis.
        Ther Clin Risk Manag. 2021; 17: 127-133
        • Galland R.
        • Traeger J.
        • Arkouche W.
        • Delawari E.
        • Fouque D.
        Short daily dialysis and nutritional status.
        Am J Kid Dis. 2001; 37: S95-S98
        • Piccoli G.B.
        • Nielsen L.
        • Gendrot L.
        • Fois A.
        • Cataldo E.
        • Cabiddu y G.
        Prescripción de hemodiálisis o hemodiafiltración: Cuando un tamaño no se ajusta a toda la propuesta de un enfoque personalizado basado en la comorbilidad y el estado nutricional.
        J Clin Med. 2018; 7: 331-382
        • Banerjee T.
        • Kim S.J.
        • Astor B.
        • Shafi T.
        • Coresh J.
        • Powe N.R.
        Vascular access type, inflammatory markers, and mortality in Incident hemodialysis patients: the Choices for healthy Outcomes in Caring for End-stage Renal Disease (CHOICE) Study.
        Am J Kidney Dis. 2014; 64: 954-961
        • Yeh L.M.
        • Chiu S.H.
        • Lai P.C.
        The impact of vascular access types on hemodialysis patient long-term Survival.
        Sci Rep. 2019; 9: 10708
        • Hung A.M.
        • Ikizler T.A.
        Hemodialysis central venous catheters as a source of inflammation and its implications.
        Semin Dial. 2008; 21: 401-404
        • Lu W.
        • Ren C.
        • Han X.
        • Yang X.
        • Cao Y.
        • Huang B.
        The protective effect of different dialysis types on residual renal function in patients with maintenance hemodialysis: a systematic review and meta-analysis.
        Medicine (Baltimore). 2018; 97: e12325
        • Liu P.J.
        • Ma F.
        • Wang Q.Y.
        • He S.L.
        The effects of oral nutritional supplements in patients with maintenance dialysis therapy: a systematic review and meta-analysis of randomized clinical trials.
        PLoS One. 2018; 13
        • Sabatino A.
        • Piotti G.
        • Cosola C.
        • Gandolfini I.
        • Kooman J.P.
        • Fiaccadori E.
        Dietary protein and nutritional supplements in conventional hemodialysis.
        Semin Dial. 2018; 31: 583-591