Original articleInflammation and nutritional status assessment by malnutrition inflammation score and its outcome in pre-dialysis chronic kidney disease patients
Introduction
Cardiovascular related complications are the most important reason for poor survival in chronic kidney Disease (CKD) patients [1]. Malnutrition-inflammation complex syndrome (MICS), hyperhomocysteinemia, calcium and phosphate levels derangement have been determined as important contributing factors for the progression of cardiovascular burden [2]. There is an association between inflammation, atherosclerosis and malnutrition in CKD, hence the term malnutrition–inflammation complex syndrome. Among patients with CKD, hypoalbuminemia and inflammation contemplated as non-traditional cardiovascular risk factors, which add more burden to circulatory disease, mortality and rapid advancement to CKD stage 5 requiring renal replacement therapy [2], [3].
The prevalence of malnutrition reported between 28 and 65% on various studies depending on criteria used in diagnosis [4], [5], [6], [7]. Malnutrition Inflammation Score (MIS) could be a valid tool in evaluating the nutritional status of pre-dialysis CKD patients [8]. Most of the previous studies on malnutrition and inflammation were carried out in ESRD patients on dialysis with only a few studies available in CKD patients not on dialysis [4], [5], [6], [9].
The aim of the study is to evaluate inflammation and nutritional status of CKD patients' not on dialysis using MIS and to study the outcome of the patients with different tertiles of MIS. This study also aims to find the association between MIS with different patient related parameters such as age, gender, estimated Glomerular filtration rate (e-GFR), BMI, anthropometry such as MAMC, MAC and TSF in our study population. The other objectives of the study is to find the correlation between MIS with inflammatory mediators such as Interleukin-6 and HsCRP in pre-dialysis CKD patients and comparison of demographic, nutrition, inflammation related factors between survivors and non-survivors.
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Study design and study participants
In this prospective, single center, study on pre-dialysis CKD patients, which included 129 pre-dialysis CKD patients in the period between June 2013 to August 2014. The patients who visited the nephrology out patient's clinic were enrolled into the study after meeting the inclusion criteria of the study. The study participants were CKD patients who met the following inclusion criteria: (i) age greater than 18 years and ≤65 years old (ii) no past history of malignancy (iii) CKD stages 3–5. The
Results
In this study 129 (66 males, 63 females) subjects were included. The study participants had a mean age of 50.6 ± 11.4 years. The clinical characteristics and demography of patients presented in Table 1.
The primary kidney disease was hypertensive nephrosclerosis (38%), diabetic nephropathy (34%) and other causes (28%). Fifteen percent of subjects had previous history of cardio vascular disease. Fifty (38.8%) subjects had stage 3 CKD (GFR range, 30–59 ml/min), 48 (37.2%) had stage 4 CKD (GFR
Discussion
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. The risk for mortality increases 13.7% with each point of MIS. MIS ≥7 is a high risk for mortality when compared with other groups of MIS. FC Amparo et al. [8] reported similar findings after comparing anthropometry and biomarkers of malnutrition with MIS which predicted the outcomes and concluded that higher MIS is related with increased risk for
Conflicts of interest
The authors declare no conflict of interest.
Acknowledgments
This study was partly funded by Sri Ramachandra University Young faculty grant (GATE).
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