Inflammation and nutritional status assessment by malnutrition inflammation score and its outcome in pre-dialysis chronic kidney disease patients

• Published in: Clinical nutrition (Edinburgh, Scotland) Scotland), 2019-02, Vol.38 (1), p.341-347
• Main Authors: Jagadeswaran, D., Indhumathi, E., Hemamalini, A.J., Sivakumar, V., Soundararajan, P., Jayakumar, M.
• Format: Article
• Language: English
• Subjects: Anthropometry; Blood Urea Nitrogen; C reactive protein; Cholesterol - blood; Cohort Studies; Comorbidity; Creatinine - blood; Female; Follow-Up Studies; Humans; Inflammation; Inflammation - blood; Inflammation - diagnosis; Inflammation - epidemiology; Interleukin – 6; Interleukin-6 - blood; Kaplan-Meier Estimate; Male; Malnutrition; Malnutrition - blood; Malnutrition - diagnosis; Malnutrition - epidemiology; Malnutrition Inflammation Score (MIS); Middle Aged; Nutritional Status - physiology; Patient Outcome Assessment; Pre-dialysis chronic kidney disease; Prospective Studies; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - epidemiology; Risk Factors; Serum Albumin; Syndrome
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1016/j.clnu.2018.01.001

Malnutrition-inflammation complex syndrome (MICS), hyperhomocysteinemia, calcium and phosphate levels derangement have been predicted as important contributing factors for the progression of cardiovascular burden. Among patients with earlier stage of CKD, hypoalbuminaemia and inflammation deliberated as non-traditional cardiovascular risk factors, which add more burden to circulatory disease, mortality and rapid advancement to CKD stage 5. The aim of the study is to evaluate inflammation and nutritional status of CKD patients not on dialysis using Malnutrition inflammation score (MIS) and to verify the association with mortality in the follow-up period. In this prospective cohort study 129 (66 males, 63 females) pre-dialysis CKD patients enrolled between June 2013 to August 2014 and censored until March 2017. Malnutrition and Inflammation assessed using Malnutrition inflammation score. Blood urea nitrogen, serum creatinine, albumin, Interleukin – 6, highly sensitive C reactive protein (hsCRP), total cholesterol and anthropometric data were analyzed. The Malnutrition inflammation score in pre-dialysis CKD patients ranged from 0 to 18 with the median score of two. During 36 or more months of follow-up, there were 30 (23.2%) deaths, 35 (27%) patients initiated on hemodialysis, one (0.7%) patient was initiated on peritoneal dialysis, two (1.4%) patients underwent renal transplantation and two (1.4%) patients were lost for follow-up. In this study, 33% had varying degree of malnutrition and inflammation. Patients who had MIS ≥7 had significant increase in IL-6 (p = 0.003) and HsCRP levels (p