INTEGRATIVE CLINICAL NUTRITION DIALYSIS SCORE (ICNDS) FOR PREDICTION OF NUTRITIONAL RISK IN HEMODIALYSIS PATIENTS

Abstract

The Integrative Clinical Nutrition Dialysis Score is a new quantitative method for identifying nutritional risk in hemodialysis patients. It is based on biochemical measures and weight change taken as a part of the patient’s monthly routine care and can be accomplished within a short time following completion of laboratory results. The Scoring result is a number between 0-100 given for each patient. A higher Score indicates a good nutritional status, a lower Score represents malnutrition. The Score identifies also a monthly change in nutritional status, and patients who should receive nutritional intervention. In 59 patients, Score results were found to be significantly correlated with nutrition evaluation by the Subjective Global Assessment taken within the same month. In 165 patients, baseline score emerged as a significant inverse predictor of mortality and hospitalization: each 1-unit increase in score reduced mortality risk by 7.1%, and reduced hospitalization risk by 6.5%. A 1- unit increase of slope of monthly scores reduced mortality risk by 23.6% and reduced hospitalization risk by 20.1%. A threshold of Score greater or equal to 75 reduced mortality by 64.2%. Patients were divided into four categories based on baseline score (above/equal or below a threshold of 75) and slope of monthly scores (smaller or larger/equal to 0). Worsening nutrition status over time as indicated by both score and slope , significantly increased death hazard. Results confirm that Integrative Clinical Nutrition Dialysis Score (ICNDS) is a simple, useful prognostic tool to reflect hemodialysis patients nutrition status, and nutrition deterioration at its very commencement.