title: Comparison analysis of nutritional scores for serial monitoring of nutritional status in hemodialysis patients.
abstract: OBJECTIVE
  This study aimed to compare the longitudinal performance of the malnutrition-inflammation score (MIS) and the geriatric nutritional risk index (GNRI), two nutritional scores for patients on maintenance hemodialysis.
  
  
  METHODS
  Nutritional scores, dietary intake, biochemical markers, and body composition analysis were performed at baseline and at 6, 12, and 18 months after enrollment (which took place from January through December 2006) on 75 prevalent hemodialysis patients (43% women, mean age 64.8 ± 11.9 years). The patients underwent simultaneous MIS and GNRI assessments calculated by two independent examiners from baseline. The study period was 46.8 ± 16.4 months.
  
  
  RESULTS
  GNRI had higher interobserver agreement (weighted κ-score 0.98) than MIS (weighted κ-score 0.62). Longitudinally, a 1-unit increase in MIS was associated with a 0.41 kcal/kg per day reduction in daily energy intake (P<0.001) and with a 0.014 g/kg per day reduction in nPNA (P=0.02). GNRI did not correlate with the change over time of dietary intake. Longitudinal changes of both scores were associated with appropriate changes over time in levels of nutritional biomarkers, inflammation (IL-6), and body composition parameters. Both scores expressed significant associations with prospective hospitalization, whereas only MIS was associated with mortality in this cohort. The multivariate Cox proportional hazard ratio was 1.15 for death for each 1-unit increase in the MIS (95% confidence interval, 1.03-1.3; P=0.02).
  
  
  CONCLUSIONS
  Both MIS and GNRI are valid tools for longitudinal assessment of hemodialysis patients' nutritional status. MIS has lower interobserver reproducibility than GNRI; however, MIS is more comprehensive than GNRI.
authors: Nephrology Division, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel. iliab@asaf.health.gov.il
authors: Ilia
authors: I
authors: Beberashvili
authors: Ada
authors: A
authors: Azar
authors: Inna
authors: I
authors: Sinuani
authors: Hadas
authors: H
authors: Kadoshi
authors: Gregory
authors: G
authors: Shapiro
authors: Leonid
authors: L
authors: Feldman
authors: Zhan
authors: Z
authors: Averbukh
authors: Joshua
authors: J
authors: Weissgarten
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001823:Body Composition; D004032:Diet; D005260:Female; D015577:Geriatric Assessment; D006760:Hospitalization; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D008875:Middle Aged; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D015415:Biomarkers