Association Between “Malnutrition Inflammation Score” and Airway Obstruction in Patients Awaiting Renal Transplantation: A Preliminary Study

Abstract

Background A chronic inflammatory state is a prominent feature in patients with end-stage renal disease (ESRD) who are undergoing maintenance hemodialysis (MHD). “Malnutrition Inflammation Score” (MIS) is a comprehensive scoring system that measures nutrition and inflammation in MHD patients. Inflammation and malnutrition are important risk factors in ESRD patients with pulmonary diseases. The aim of the study was to determine if pulmonary dysfunction, as assessed by airway obstruction, was associated with malnutrition and inflammatory factors in ESRD patients awaiting renal transplantation (RT). Methods Patients with ESRD who were on MHD and had pulmonary function tests (PFTs) were retrospectively enrolled in the study. Patients' renal function tests, albumin, C-reactive protein (CRP) levels, white blood cell count, and PFTs (forced expiratory flow rate in one second [FEV1], forced vital capacity [FVC], forced expiratory flow at 25%–75% [FEF25%–75%], and peak expiratory flow [PEF]) were recorded. MIS was calculated for each patient. Results A total of 81 patients (male = 54; mean age: 50.6 ± 13 years) were recruited. Mean body mass index (BMI) was 22.5 ± 4.4 kg/m 2, mean MIS was 7.1 ± 3.3, mean CRP level was 24.9 ± 48.1 mg/L, mean FEV1% was 94 ± 22, and mean FEF25%–75% was found to be 72.3 ± 30.3. Mean duration of MHD was 10.5 ± 5.2 years. There was a negative correlation between FEV1, FVC, FEF25%– 75%, PEF, and MIS ( r = −0.3, P = .00; r = −0.32, P = .00; r = −0.22, P = .04; r = −0.30, P = .00, respectively). Nevertheless, FEV1 values significantly correlated with BMI ( P = .03) and the MIS ( P = .00). Conclusion Impaired pulmonary function could be a marker of inflammation and malnutrition in ESRD patients awaiting RT. Prospective studies are needed to investigate the relationship between pulmonary function, inflammation, and malnutrition in larger populations of ESRD patients. Treatment geared towards malnutrition and inflammation markers may help maintain PFTs within normal range, which may prevent pulmonary complications following RT.