Diagnostic validation and prognostic significance of the Malnutrition-Inflammation Score in nondialyzed chronic kidney disease patients

Malnutrition and inflammation are highly prevalent and intimately linked conditions in chronic kidney disease (CKD) patients that lead to a state of protein-energy wasting (PEW), the severity of which can be assessed by the Malnutrition-Inflammation Score (MIS). Here, we applied MIS and validated, for the first time, its ability to grade PEW and predict mortality in nondialyzed CKD patients.We cross-sectionally evaluated 300 CKD stages 3-5 patients [median age 61 (53-68) years; estimated glomerular filtration rate 18 (12-27) mL/min/1.73 m(2); 63% men] referred for the first time to our center. Patients were followed during a median 30 (18-37) months for all-cause mortality.A worsening in MIS scale was associated with inflammatory biomarkers increase (i.e. alpha-1 acid glycoprotein, fibrinogen, ferritin and C-reactive protein) as well as a progressive deterioration in various MIS-independent indicators of nutritional status based on anthropometrics, dynamometry, urea kinetics and bioelectric impedance analysis. A structural equation model with two latent variables (assessing simultaneously malnutrition and inflammation factors) demonstrated good fit to the observed data. During a follow-up, 71 deaths were recorded; patients with higher MIS were at increased mortality risk in both crude and adjusted Cox models.MIS appears to be a useful tool to assess PEW in nondialyzed CKD patients. in addition, MIS identified patients at increased mortality risk.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Adib Jatene's FoundationSwedish Research CouncilDante Pazzanese Inst Cardiol, Dept Nutr, São Paulo, BrazilUniversidade Federal de São Paulo, Div Nephrol, Nutr Program, São Paulo, BrazilUniv Tennessee, Hlth Sci Ctr, Div Nephrol, Dept Med, Memphis, TN USAKarolinska Inst, Dept Clin Sci Intervent & Technol, Div Renal Med, Stockholm, SwedenKarolinska Inst, Dept Clin Sci Intervent & Technol, Baxter Novum, Stockholm, SwedenKarolinska Inst, Ctr Mol Med, Stockholm, SwedenDante Pazzanese Inst Cardiol, Dept Hypertens & Nephrol, São Paulo, BrazilUniversidade Federal de São Paulo, Div Nephrol, Nutr Program, São Paulo, BrazilFAPESP: 2010/16593-2Web of Scienc