Assessment of Severity of Malnutrition in Peritoneal Dialysis Patients via Malnutrition: Infl ammatory Score

Document Type : Original Article


1 Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran

4 General Practitioner, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

5 Department of Nephrology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

6 Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Regarding to the complications of malnutrition in dialysis patients, using an easy and reliable method for evaluating of malnutrition is important in patients with the end-stage renal disease. Based on the effect of inflammatory factors in malnutrition, A new scale has been designed which is called malnutrition–inflammatory scale (MIS). We designed current study to assess the severity of malnutrition in peritoneal dialysis patients in Isfahan via MIS. Materials and Methods: In this cross-sectional MIS was used for evaluation of malnutrition. MIS includes 10 components: dry weight changes, dietary intake, functional capacity, comorbidity, muscle wasting and loss of subcutaneous fat as well as body mass index (BMI), serum albumin level and total iron binding capacity (TIBC). Each component has four levels of severity from 0 (normal) to 3 (severely abnormal). All analyses were performed using Statistical Package for Social Sciences version 20 (SPSS 20) and P < 0.05 were considered statistically significant. Results: Results showed no significant difference in MIS between male and female participants. Mean of minimum inhibitory concentration in this study was calculated about 4.1 (MIS <9) which means no or mild malnutrition. Significant correlation between MIS and weight (P < 0.001), BMI (P < 0.001), TIBC (P < 0.001), triglyseride (P = 0.04) and arm circumference (P < 0.001) was seen. Conclusion: We suggest That MIS is being used as a valuable tool for prevention of fatal outcomes in chronic dialysis patients.


Bossola M, Muscaritoli M, Tazza L, Giungi S, Tortorelli A, Rossi Fanelli F, et al. Malnutrition in hemodialysis patients: What therapy? Am J Kidney Dis 2005;46:].  Back to cited text no. 1
Stenvinkel P, Heimbürger O, Lindholm B, Kaysen GA, Bergström J. Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrol Dial Transplant 2000;15:].  Back to cited text no. 2
Afshar R, Sanavi S, Izadi-Khah A. Assessment of nutritional status in patients undergoing maintenance hemodialysis: A single-center study from Iran. Saudi J Kidney Dis Transpl 2007;18:397-404.  Back to cited text no. 3
[PUBMED]  [Full text]  
Diamond SM, Henrich WL. Nutrition and peritoneal dialysis. In: Mitch WE, Klahr S, editors. Nutrition and the Kidney. Boston: Little, Brown; 1988. p. 198-223.  Back to cited text no. 4
Marckmann P. Nutritional status of patients on hemodialysis and peritoneal dialysis. Clin Nephrol 1988;29:75-8.  Back to cited text no. 5
Young GA, Kopple JD, Lindholm B, Vonesh EF, De Vecchi A, Scalamogna A, et al. Nutritional assessment of continuous ambulatory peritoneal dialysis patients: An international study. Am J Kidney Dis 1991;17:462-71.  Back to cited text no. 6
Yýlmaz MY. The causes of the inflammation and possible therapeutic options in dialysis patients. Gulhane Med J 2007;49:271-6.  Back to cited text no. 7
Enia G, Sicuso C, Alati G, Zoccali C. Subjective global assessment of nutrition in dialysis patients. Nephrol Dial Transplant 1993;8:1094-8.  Back to cited text no. 8
Duerksen DR, Yeo TA, Siemens JL, O'Connor MP. The validity and reproducibility of clinical assessment of nutritional status in the elderly. Nutrition 2000;16:740-4.  Back to cited text no. 9
Kalantar-Zadeh K, Ikizler A, Block G, Avram M, Kopple J. Malnutrition-inflammation complex syndrome in dialysis patients: Causes and consequences. Am J Kidney Dis 2003;42:864-81.  Back to cited text no. 10
Davies SJ, Phillips L, Naish PF, Russell GI. Quantifying comorbidity in peritoneal dialysis patients and its relationship to other predictors of survival. Nephrol Dial Transplant 2002;17:1085-92.  Back to cited text no. 11
Saxena A, Sharma RK. An update on methods for assessment of nutritional status in maintenance dialysis patients. Indian J Nephrol 2004;14:61-6.  Back to cited text no. 12
  [Full text]  
Steiber AL, Kalantar-Zadeh K, Secker D, McCarthy M, Sehgal A, McCann L. Subjective global assessment in chronic kidney disease: A review. J Ren Nutr 2004;14:191-200.  Back to cited text no. 13
Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH. A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. Am J Kidney Dis 2001;38:1251-63.  Back to cited text no. 14
Kalantar-Zadeh K, Kleiner M, Dunne E, Lee GH, Luft FC. A modified quantitative subjective global assessment of nutrition for dialysis patients. Nephrol Dial Transplant 1999;14:1732-8.  Back to cited text no. 15
González-Ortiz AJ, Arce-Santander CV, Vega-Vega O, Correa-Rotter R, Espinosa-Cuevas Mde L. Assessment of the reliability and consistency of the “malnutrition inflammation score” (MIS) in Mexican adults with chronic kidney disease for diagnosis of protein-energy wasting syndrome (PEW). Nutr Hosp 2014;31:1352-8.  Back to cited text no. 16
Lopes AA. The malnutrition-inflammation score: A valid nutritional tool to assess mortality risk in kidney transplant patients. Am J Kidney Dis 2011;58:7-9.  Back to cited text no. 17
Steiber AL, Handu DJ, Cataline DR, Deighton TR, Weatherspoon LJ. The impact of nutrition intervention on a reliable morbidity and mortality indicator: The hemodialysis-prognostic nutrition index. J Ren Nutr 2003;13:186-90.  Back to cited text no. 18