New score correlates with morbidity, mortality in long-term hemodialysis patients

NEW YORK (Reuters Health) – A comprehensive, quantitative Malnutrition-Inflammation Score (MIS) developed by California investigators is a good predictor of outcome in patients undergoing long-term hemodialysis, according to a new study.

Last Updated: 2001-12-26 11:45:52 EST (Reuters Health)

As reported in the American Journal of Kidney Diseases for December, the MIS score is based on a modified Dialysis Malnutrition Score to which are added body mass index, serum albumin level, and total iron-binding capacity. The MIS score ranges from a normal of zero to a maximum of 30, which correlates with severe malnourishment.

The Dialysis Malnutrition Score (DMS), in turn, is comprised of modified elements of the Subjective Global Assessment (SGA) of nutritional states: weight change, dietary intake, GI symptoms, functional capacity, duration of dialysis and morbidity, subcutaneous fat, and muscle wasting.

Dr. Kamyar Kalantar-Zadeh, of Harbor-UCLA Medical Center in Torrance, and associates evaluated the DMS, SGA and MIS in 83 patients, ages 22 to 87 years. Patients had undergone chronic intermittent dialysis therapy for a mean of 43 months, ranging from 4 months to 12 years. During 12 months of follow-up, 46 patients were admitted to a hospital at least one time each, and nine patients died.

The MIS was better at predicting hospitalization and mortality than either the SGA or the DMS. Furthermore, the MIS was a more powerful predictor of first hospitalization and of mortality than any of its 10 components.

For each 10-unit increase in MIS, the relative risk for first hospital admission was 3.83, and the relative risk for mortality was 10.43.

Dr. Kalantar-Zadeh's group notes that attention to a global measure of nutritional and inflammatory status should improve outcomes among patients with end-stage renal disease. More comparative and longitudinal studies will demonstrate whether the MIS represents such a tool.

According to an accompanying editorial, the MIS method is valuable because of its association with high risks of morbidity and mortality. In addition, Dr. William E. Mitch, of Emory University School of Medicine in Atlanta, Georgia, writes, its methodology lends itself to use by personnel in the dialysis unit.

Am J Kidney Dis 2001;38:1251-1263, 1318-1320

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