The use of the Nutritional Screening Test Malnutrition Inflammation Score (MIS) in Dialysis

Abstract

Protein-energy malnutrition is one of the most common complications in chronic renal failure patients who are treated with hemodialysis, especially in the elderly and in patients who have a long dialysis history. Protein-energy malnutrition is associated with higher rates of mortality and morbidity, and also with a greater risk of cardiovascular death in dialysis patients. The importance of nutritional status evaluation and treatment is underlined by some guidelines, such as Kidney Disease Outcomes Quality Initiative. Nutritional screening should be an easy and fast tool that should be undertaken during the first meeting with the patient and when the patient is hospitalized or registered in other institutions. Scientific literature (see for example Kalantar-Zadeh et al) shows that Malnutrition Inflammation Score (MIS) seems to have a high capability in discriminating malnutrition, inflammatory status and anemia and that it seems to be highly predictive for morbidity (number of hospitalizations) and mortality. The objectives of these studies were the perspective of the administration of the MIS to a group of patients treated with hemodialysis in the SCUD (Departmental and University Complex Structure) of Dialysis and Nephrology of Saint Giovanni Bosco Hospital in Turin and the evaluation of the nutritional intervention effects. One of the goal of this study was the involvement of registered nurses, under the coordination of the registered dietitian, in order to have an integrated approach to the problem. In our experience, the monitoring of patients treated with hemodialysis who have been screened to evaluate their nutritional status with an easy and repeatable procedure allows to express some considerations. If we keep in mind the common shortage of registered dietitians in dialysis units, being able to engage registered nurses trained and sensible to the problem of malnutrition, it represents a useful tool to improve the quality of dialysis patients life. Being aware of the MIS is an added value to the professional knowledge of the registered nurses in dialysis units and even more when a professional relation is created between the registered dietitian and the medical doctor involved. Focusing on malnutrition becomes essential because of the changing of the population in dialysis we are observing and for this reason it is important to have and use low-cost screening procedures. The experience of the Dietetic and Clinical Nutrition Unit and of the Dialysis Unit is a very positive one, thanks to the sharing of this project that highlights a multidisciplinary and multiprofessional approach.