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Inflammation and nutritional status assessment by malnutrition inflammation score and its outcome in pre-dialysis chronic kidney disease patients
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 deliberate...
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| Published in: | Clinical nutrition (Edinburgh, Scotland) Scotland), 2019-02, Vol.38 (1), p.341-347 |
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| creator | Jagadeswaran, D. Indhumathi, E. Hemamalini, A.J. Sivakumar, V. Soundararajan, P. Jayakumar, M. |
| description | 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 |
| doi_str_mv | 10.1016/j.clnu.2018.01.001 |
| format | article |
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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 < 0.001) when compared with other tertiles of MIS. ROC curve analysis of MIS showed 56.5% sensitivity and 81% specificity in predicting death rate (AUC 0.709; 95% CI 0.604–0.815, p < 0.001). Kaplan–Meier survival analysis showed MIS ≥7 had a strong association (log rank test, p < 0.001) with mortality during 36 and more months of follow-up time. In unadjusted analyses, MIS (HR 1.140; 95% CI 1.054–1.233; p < 0.05) and HsCRP (HR 2.369; 95% CI 1.779–3.154; p < 0.001) found to be predictors of mortality. MIS and HsCRP remained predictors of mortality even after adjustments.
This study shows MIS is an important factor that determines mortality in pre-dialysis CKD patients during 36 and more months of follow-up time. Patients with MIS ≥7 have high risk for mortality and needs close monitoring. In clinical setting application of MIS has a greater utilization in pre-dialysis CKD patients. Further research with longitudinal assessment of MIS and its association with outcomes are warranted. Pre-dialysis CKD patients should be assessed for their nutritional status and inflammation using MIS regularly to prevent malnutrition and its associated complications through appropriate medical and nutritional intervention.</description><identifier>ISSN: 0261-5614</identifier><identifier>EISSN: 1532-1983</identifier><identifier>DOI: 10.1016/j.clnu.2018.01.001</identifier><identifier>PMID: 29398341</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>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</subject><ispartof>Clinical nutrition (Edinburgh, Scotland), 2019-02, Vol.38 (1), p.341-347</ispartof><rights>2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism</rights><rights>Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c422t-63159418add0bfd032a9ec3476b456735a689ee0b9685bd691519af6e1df4a6b3</citedby><cites>FETCH-LOGICAL-c422t-63159418add0bfd032a9ec3476b456735a689ee0b9685bd691519af6e1df4a6b3</cites><orcidid>0000-0002-8449-4479 ; 0000-0001-7335-7965</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29398341$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jagadeswaran, D.</creatorcontrib><creatorcontrib>Indhumathi, E.</creatorcontrib><creatorcontrib>Hemamalini, A.J.</creatorcontrib><creatorcontrib>Sivakumar, V.</creatorcontrib><creatorcontrib>Soundararajan, P.</creatorcontrib><creatorcontrib>Jayakumar, M.</creatorcontrib><title>Inflammation and nutritional status assessment by malnutrition inflammation score and its outcome in pre-dialysis chronic kidney disease patients</title><title>Clinical nutrition (Edinburgh, Scotland)</title><addtitle>Clin Nutr</addtitle><description>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 < 0.001) when compared with other tertiles of MIS. ROC curve analysis of MIS showed 56.5% sensitivity and 81% specificity in predicting death rate (AUC 0.709; 95% CI 0.604–0.815, p < 0.001). Kaplan–Meier survival analysis showed MIS ≥7 had a strong association (log rank test, p < 0.001) with mortality during 36 and more months of follow-up time. In unadjusted analyses, MIS (HR 1.140; 95% CI 1.054–1.233; p < 0.05) and HsCRP (HR 2.369; 95% CI 1.779–3.154; p < 0.001) found to be predictors of mortality. MIS and HsCRP remained predictors of mortality even after adjustments.
This study shows MIS is an important factor that determines mortality in pre-dialysis CKD patients during 36 and more months of follow-up time. Patients with MIS ≥7 have high risk for mortality and needs close monitoring. In clinical setting application of MIS has a greater utilization in pre-dialysis CKD patients. Further research with longitudinal assessment of MIS and its association with outcomes are warranted. Pre-dialysis CKD patients should be assessed for their nutritional status and inflammation using MIS regularly to prevent malnutrition and its associated complications through appropriate medical and nutritional intervention.</description><subject>Anthropometry</subject><subject>Blood Urea Nitrogen</subject><subject>C reactive protein</subject><subject>Cholesterol - blood</subject><subject>Cohort Studies</subject><subject>Comorbidity</subject><subject>Creatinine - blood</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Inflammation</subject><subject>Inflammation - blood</subject><subject>Inflammation - diagnosis</subject><subject>Inflammation - epidemiology</subject><subject>Interleukin – 6</subject><subject>Interleukin-6 - blood</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Malnutrition</subject><subject>Malnutrition - blood</subject><subject>Malnutrition - diagnosis</subject><subject>Malnutrition - epidemiology</subject><subject>Malnutrition Inflammation Score (MIS)</subject><subject>Middle Aged</subject><subject>Nutritional Status - physiology</subject><subject>Patient Outcome Assessment</subject><subject>Pre-dialysis chronic kidney disease</subject><subject>Prospective Studies</subject><subject>Renal Insufficiency, Chronic - blood</subject><subject>Renal Insufficiency, Chronic - epidemiology</subject><subject>Risk Factors</subject><subject>Serum Albumin</subject><subject>Syndrome</subject><issn>0261-5614</issn><issn>1532-1983</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp9kU2LFDEQhoMo7rj6BzxIjl66TXXSmQ54kcWPhQUveg7ppBozdnfGVFqYn-E_NuOsiydPoeB5nyL1MvYSRAsC9JtD6-d1azsBQyugFQIesR30smvADPIx24lOQ9NrUFfsGdFBCNHL_fCUXXVGVkLBjv26XafZLYsrMa3crYGvW8nxPLmZU3FlI-6IkGjBtfDxxBc3PzA8_hsnnzL-kcRCPG3FpwUrwo8ZmxDdfKJI3H_LaY2ef49hxRMPkdAR8mN11A30nD2Z3Ez44v69Zl8_vP9y86m5-_zx9ubdXeNV15VGS-iNgsGFIMYpCNk5g16qvR5Vr_eyd3owiGI0eujHoA30YNykEcKknB7lNXt98R5z-rEhFbtE8jjPbsW0kQVjlNRCKFHR7oL6nIgyTvaY4-LyyYKw5yrswZ6rsOcqrABbq6ihV_f-bVwwPET-3r4Cby8A1l_-jJgt-XoBjyFm9MWGFP_n_w2qip6j</recordid><startdate>201902</startdate><enddate>201902</enddate><creator>Jagadeswaran, D.</creator><creator>Indhumathi, E.</creator><creator>Hemamalini, A.J.</creator><creator>Sivakumar, V.</creator><creator>Soundararajan, P.</creator><creator>Jayakumar, M.</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8449-4479</orcidid><orcidid>https://orcid.org/0000-0001-7335-7965</orcidid></search><sort><creationdate>201902</creationdate><title>Inflammation and nutritional status assessment by malnutrition inflammation score and its outcome in pre-dialysis chronic kidney disease patients</title><author>Jagadeswaran, D. ; Indhumathi, E. ; Hemamalini, A.J. ; Sivakumar, V. ; Soundararajan, P. ; Jayakumar, M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c422t-63159418add0bfd032a9ec3476b456735a689ee0b9685bd691519af6e1df4a6b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Anthropometry</topic><topic>Blood Urea Nitrogen</topic><topic>C reactive protein</topic><topic>Cholesterol - blood</topic><topic>Cohort Studies</topic><topic>Comorbidity</topic><topic>Creatinine - blood</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Inflammation</topic><topic>Inflammation - blood</topic><topic>Inflammation - diagnosis</topic><topic>Inflammation - epidemiology</topic><topic>Interleukin – 6</topic><topic>Interleukin-6 - blood</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Malnutrition</topic><topic>Malnutrition - blood</topic><topic>Malnutrition - diagnosis</topic><topic>Malnutrition - epidemiology</topic><topic>Malnutrition Inflammation Score (MIS)</topic><topic>Middle Aged</topic><topic>Nutritional Status - physiology</topic><topic>Patient Outcome Assessment</topic><topic>Pre-dialysis chronic kidney disease</topic><topic>Prospective Studies</topic><topic>Renal Insufficiency, Chronic - blood</topic><topic>Renal Insufficiency, Chronic - epidemiology</topic><topic>Risk Factors</topic><topic>Serum Albumin</topic><topic>Syndrome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jagadeswaran, D.</creatorcontrib><creatorcontrib>Indhumathi, E.</creatorcontrib><creatorcontrib>Hemamalini, A.J.</creatorcontrib><creatorcontrib>Sivakumar, V.</creatorcontrib><creatorcontrib>Soundararajan, P.</creatorcontrib><creatorcontrib>Jayakumar, M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical nutrition (Edinburgh, Scotland)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jagadeswaran, D.</au><au>Indhumathi, E.</au><au>Hemamalini, A.J.</au><au>Sivakumar, V.</au><au>Soundararajan, P.</au><au>Jayakumar, M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Inflammation and nutritional status assessment by malnutrition inflammation score and its outcome in pre-dialysis chronic kidney disease patients</atitle><jtitle>Clinical nutrition (Edinburgh, Scotland)</jtitle><addtitle>Clin Nutr</addtitle><date>2019-02</date><risdate>2019</risdate><volume>38</volume><issue>1</issue><spage>341</spage><epage>347</epage><pages>341-347</pages><issn>0261-5614</issn><eissn>1532-1983</eissn><abstract>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 < 0.001) when compared with other tertiles of MIS. ROC curve analysis of MIS showed 56.5% sensitivity and 81% specificity in predicting death rate (AUC 0.709; 95% CI 0.604–0.815, p < 0.001). Kaplan–Meier survival analysis showed MIS ≥7 had a strong association (log rank test, p < 0.001) with mortality during 36 and more months of follow-up time. In unadjusted analyses, MIS (HR 1.140; 95% CI 1.054–1.233; p < 0.05) and HsCRP (HR 2.369; 95% CI 1.779–3.154; p < 0.001) found to be predictors of mortality. MIS and HsCRP remained predictors of mortality even after adjustments.
This study shows MIS is an important factor that determines mortality in pre-dialysis CKD patients during 36 and more months of follow-up time. Patients with MIS ≥7 have high risk for mortality and needs close monitoring. In clinical setting application of MIS has a greater utilization in pre-dialysis CKD patients. Further research with longitudinal assessment of MIS and its association with outcomes are warranted. Pre-dialysis CKD patients should be assessed for their nutritional status and inflammation using MIS regularly to prevent malnutrition and its associated complications through appropriate medical and nutritional intervention.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>29398341</pmid><doi>10.1016/j.clnu.2018.01.001</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-8449-4479</orcidid><orcidid>https://orcid.org/0000-0001-7335-7965</orcidid></addata></record> |
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| ispartof | Clinical nutrition (Edinburgh, Scotland), 2019-02, Vol.38 (1), p.341-347 |
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| 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 |
| title | Inflammation and nutritional status assessment by malnutrition inflammation score and its outcome in pre-dialysis chronic kidney disease patients |
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