Diagnostic validation and prognostic significance ofthe Malnutrition-Inflammation Score in nondialyzed chronickidney disease patients

ABSTRACT

Malnutrition and inflammation are highlyprevalent and intimately linked conditions in chronic kidneydisease (CKD) patients that lead to a state of protein-energywasting (PEW), the severity of which can be assessed by theMalnutrition-Inflammation Score (MIS). Here, we appliedMIS and validated, for the first time, its ability to grade PEWand predict mortality in nondialyzed CKD patients.Methods. We cross-sectionally evaluated 300 CKD stages 3–5patients [median age 61 (53–68) years; estimated glomerularfiltration rate 18 (12–27) mL/min/1.73 m2; 63% men] referredfor the first time to our center. Patients were followed during amedian 30 (18–37) months for all-cause mortality.Results. A worsening in MIS scale was associated withinflammatory biomarkers increase (i.e. alpha-1 acidglycoprotein, fibrinogen, ferritin and C-reactive protein) aswell as a progressive deterioration in various MIS-independentindicators of nutritional status based on anthropometrics, dynamometry,urea kinetics and bioelectric impedance analysis.A structural equation model with two latent variables (assessingsimultaneously malnutrition and inflammation factors)demonstrated good fit to the observed data. During a followup,71 deaths were recorded; patients with higher MIS were atincreased mortality risk in both crude and adjusted Coxmodels.Conclusions. MIS appears to be a useful tool to assess PEW innondialyzed CKD patients. In addition, MIS identified patientsat increased mortality risk.