Abstract
Chronic protein-energy wasting, termed malnutrition-inflammation complex syndrome, is frequent in patients with chronic kidney disease and is associated with anemia, morbidity, and mortality in patients on maintenance dialysis therapy. The Malnutrition-Inflammation Score (MIS) recently has been developed and validated in dialysis patients. Observational cross-sectional study. 993 prevalent kidney transplant recipients. MIS computed from change in body weight, dietary intake, gastrointestinal symptoms, functional capacity, comorbid conditions, decreased fat store/Systemic Global Assessment, signs of muscle wasting/Systemic Global Assessment, body mass index, serum albumin level, and serum transferrin level. Markers of inflammation and malnutrition, including serum C-reactive protein, interleukin 6, tumor necrosis factor alpha, serum leptin, prealbumin, body mass index, and abdominal circumference. The relationship was modeled by using structural equation models. Mean age was 51 +/- 13 years, 57% were men, and 21% had diabetes. Median time from transplant was 72 months. MIS significantly correlated with abdominal circumference (r = -0.144), serum C-reactive protein level (r = 0.094), serum interleukin 6 level (r = 0.231), and serum tumor necrosis factor alpha level (r = 0.102; P < 0.01 for all). A structural equation model with 2 latent variables (malnutrition and inflammation factor) showed good fit to the observed data. Single-center study, lack of information about vascular access, presence of nonfunctioning kidney transplant, relatively high refusal rate. Our results confirm that MIS reflects both energy-protein wasting and inflammation in kidney transplant recipients. This simple instrument appears to be a useful tool to assess the presence of protein-energy wasting in this patient population.
Highlights
Chronic protein-energy wasting, termed malnutrition-inflammation complex syndrome, is frequent in patients with chronic kidney disease and is associated with anemia, morbidity, and mortality in patients on maintenance dialysis therapy
We report data that confirm that Malnutrition-Inflammation Score (MIS) is a useful tool to measure nutritional status and inflammation and to assess malnutritioninflammation complex syndrome (MICS) in kidney transplant recipients
Results of our structural equation modeling suggest that both inflammation and nutritional status are represented in the MIS
Summary
Chronic protein-energy wasting, termed malnutrition-inflammation complex syndrome, is frequent in patients with chronic kidney disease and is associated with anemia, morbidity, and mortality in patients on maintenance dialysis therapy. Conclusions: Our results confirm that MIS reflects both energy-protein wasting and inflammation in kidney transplant recipients. Before its widespread application in this special patient population, it has to be shown that it is correlated with serum markers of inflammation and nutritional status To this end, we analyzed the association of MIS with nutritional and inflammatory markers, such as abdominal circumference and concentrations of serum prealbumin and leptin, serum CRP, interleukin 6 (IL-6), and tumor necrosis factor ␣ (TNF-␣). We wanted to show that the MIS reflects both inflammation and wasting; in other words, that the MIS measures MICS To test this hypothesis, we built structural equation models to analyze the complex network of associations between the different malnutrition markers and inflammatory cytokines and the MIS itself
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