MP589A MALNUTRITION INFLAMMATION SCORE (MIS) PREDICTS PATIENT’S OUTCOMES AND GIVES SPECIFIC STRATEGIES TO IMPROVE THE MORTALITY OF MAINTENANCE DIALYSIS PATIENTS

Abstract

Introduction and Aims: Most of the dialysis patients present with signs of malnutrition at the initiation of dialysis therapy. There are many causes affects to nutritional status of these patients. Protein-energy wasting and inflammations are representative examples of the causes of their malnutrition. Past researches reported that the nutritional status of dialysis patient was correlated with their increased morbidity and mortality. Therefore, the nutritional assessment and nutritional intervention for dialysis patients are important. Several factors such as ureic toxin accumulation, aging, dietary restriction, nutrient loss during dialysis therapy, etc. could influence their nutritional status. MIS was reported by Kalanter-Zadeh in 2001 as comprehensive assessment tool of malnutrition inflammation complex syndrome of dialysis patients. MIS consists of 10 components. In this study, we validated the utility of the MIS and analyzed which component had the most effect on their mortality. Methods: This research was a retrospective cohort study. 319 hemodialysis patients ( 209 men, 110 women; age, 65.5 ± 12.9 years) were enrolled in this study. The MIS was assessed on all 319 patients by trained nutritionists at December 2009. They were followed up for 5 years. All patients were classified into three subgroups corresponding to each MIS total points, normal nutritional group (MIS 0-3), mildly impaired group (MIS 4-7), severely impaired group (MIS over 8) respectively. The survival rates were compared among the three groups using the Kaplan-Meier analysis. The Cox's proportional hazard model was used in multivariate analyses of survival data adjusted for age, sex, BMI and diabetes. Results: Five year survival rates of the normal group, the mildly impaired group and severely impaired group were 92.6%, 84.8% and 65.2% respectively. And we found a significant difference in the mortality between the severely impaired group and the other two groups with a Log-Rank test. Among 10 MIS components, only the degree of functional capacity (nutritional related functional impairment) affected to their mortality independently (HR 1.33; 95% C.I. 1.03-1.70; p=0.03). Conclusions: MIS is a comprehensive and multidisciplinary nutritional assessment tool and consists of 10 components (weight change, dietary intake, gastrointestinal symptom, functional capacity, vintage and morbidity, subcutaneous fat, muscle wasting, BMI, albumin, TIBC). It is very meaningful that there are 10 components in MIS. According to the scores of each component, we can design therapeutic strategies for patients with malnutrition. In this study, the degree of functional capacity (mobility) was an only significant prognostic factor among the 10 MIS components. Recent study revealed that elder dialysis patients loose their motor function rapidly after the initiation of dialysis therapy. The patient's group under this study was comparatively old. These results suggested that the rehabilitation and exercise programs are required to prevent or slow motor function decline of elderly dialysis patients and it will improve their nutrition and mortality. A MIS component of which affect to patient's mortality might be deferent depending on the characteristics of subject group. In conclusion, a comprehensive and multidisciplinary assessment procedure is very important to manage the malnutrition of dialysis patents.