Are Nutritional Composed Scoring Systems and Protein-Energy Wasting Score Associated With Mortality in Maintenance Hemodialysis Patients?

Abstract

Objective: The diagnostic of protein-energy wasting should be done using a tool that can predict clinically important outcomes, besides identifying malnutrition. This study investigated which nutritional composed scoring systems best predicts all-cause mortality in maintenance hemodialysis patients. Design and Methods: Cohort study that included prevalent patients undergoing hemodialysis for at least 1 month. To assess nutritional status, Subjective Global Assessment (SGA), Malnutrition-Inflammation Score (MIS), and diagnostic criteria for protein-energy wasting proposed by the International Society of Renal Nutrition and Metabolism (ISRNM) were used. Patients were assessed in the moment of inclusion in the study (between July 2012 and December 2012) and followed prospectively to verify the occurrence of deaths. Results: A total of 163 patients were included, 54.6% were male, and mean age was 58.4 ± 15.5 years. During the follow-up period (15.5 ± 5.4 months), 29 patients died and 16 underwent kidney transplant. Kaplan-Meier survival curves and Cox proportional hazard analysis adjusted for age, gender, dialysis vintage, diabetes, and serum urea showed that SGA and MIS were predictors of all-cause mortality. Conclusion: Of the 3 investigated scoring systems, SGA and MIS predict mortality in a period of 15.5 ± 5.4 months of follow-up.