title: Diagnostic validation and prognostic significance of the Malnutrition-Inflammation Score in nondialyzed chronic kidney disease patients.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  MIS appears to be a useful tool to assess PEW in nondialyzed CKD patients. In addition, MIS identified patients at increased mortality risk.
authors.affiliation: Department of Nutrition, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil Nutrition Program, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Fernanda C
authors.initials: FC
authors.lastname: Amparo
authors.affiliation: Nutrition Program, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Kamimura
authors.affiliation: Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Miklos Z
authors.initials: MZ
authors.lastname: Molnar
authors.affiliation: Nutrition Program, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Lilian
authors.initials: L
authors.lastname: Cuppari
authors.affiliation: Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindholm
authors.affiliation: Department of Hypertension and Nephrology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: Celso
authors.initials: C
authors.lastname: Amodeo
authors.affiliation: Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Carrero
authors.affiliation: Department of Hypertension and Nephrology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Cordeiro
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007249:Inflammation / Q000175:diagnosis*; D008297:Male; D044342:Malnutrition / Q000175:diagnosis*; D008875:Middle Aged; D009752:Nutritional Status; D011379:Prognosis; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: acute phase response; outcomes; renal disease; undernutrition; uremia