Objective: To assess the performance of subjective global assessment (SGA), malnutrition inflammation score (MIS), and mini nutritional assessment short-form (MNA-SF) in older adults on hemodialysis (HD) by evaluating their concurrent and predictive validity.
Design: An observational and prospective study including older adults on HD.
Setting: Six dialysis units.
Subjects: We assessed 137 HD patients aged ≥60 years (71.7% male, 70.2 ± 7.2 years).
Main outcome measures: The nutritional status was assessed by 7-point SGA, MIS and MNA-SF, and by objective methods. Patients were followed up for 14.5 (8; 26.3) months (median and interquartile) to assess survival.
Results: Protein energy wasting (PEW) was present in 63% of the patients when assessed by SGA, in 77% by MIS, and in 26% by MNA-SF. Most objective parameters of patients classified with PEW were lower (P < .05) than those from patients classified as well-nourished by SGA, MIS, and MNA-SF. In addition, the hazard of death was higher for patients classified as PEW by SGA (hazard ratio 2.63 [95% confidence interval 1.14-6.00]), MIS (5.13 [1.19-13.7]), and MNA-SF (2.53 [1.34-4.77]) in comparison to well-nourished patients.
Conclusions: The prevalence of PEW varied depending on the tool applied. SGA, MIS, and MNA-SF had good concurrent and predictive validity for the assessment of nutritional status, but SGA and MIS were likely to perform better than MNA-SF.
Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.