Use of malnutrition inflammation score in hemodialysis patients by hemodialysis nurses

Abstract

Malnutrition inflammation syndrome is common in chronic hemodialysis patients and may correlate with increased morbidity and mortality. A malnutrition inflammation score (MIS) has been proposed as a comprehensive system to assess the presence of this syndrome. We evaluated MIS in a cohort of patients undergoing regular hemodialysis. Furthermore, a dietary questionnaire was administered to patients classified as malnourished according to the MIS score. The MIS score was reassessed after a mean of 22 months in the subgroup of patients still in follow-up. A total of 80 patients on regular hemodialysis (45 males and 35 females, mean age 71 ± 15 years) were studied; they were classified into 3 groups according to the MIS score: 1) 34 (42.5%) with good nutrition; 2) 35 (44%) with mild malnutrition; 3) 11 (13.5%) with moderate to severe malnutrition. Malnourished patients were significantly older than others, while the duration of dialysis was similar. Survival during 26 months' follow-up was statistically different between the 3 groups (Cox-Mantel test, p = 0.009) and was 75% in group 1, 49% in group 2 and 40% in group 3. A dietary questionnaire was administered to the 46 patients of groups 2 and 3. The results showed that in only 9% of cases dietary intake was poor, while the remaining cases were equally distributed between those with good and median intake; the MIS score was not different between the 3 groups. In 46 patients the MIS score was reassessed and had worsened significantly in patients without malnutrition at baseline; conversely, it significantly improved in those previously found to be malnourished who received dietary counseling. Our study shows that the MIS score may predict patient survival.