SUN-244 CORRELATION BETWEEN MALNUTRITION INFLAMMATION SCORE (MIS) WITH LEVEL OF TNF-ALPHA AND TOTAL ANTIOXIDANT CAPACITY (TAC) IN MAINTENANCE HEMODIALYSIS PATIENTS

Abstract

Malnutrition is common in maintenance hemodialysis (MHD) patients and has been correlated with increased morbidity and mortality. Several studies showed that the prevalence of malnutrition among routine HD patients range between 20% to 70%. Malnutrition in the MHD related to inflammation and oxidative stress. The purpose of this study was to determine the nutritional status, and its correlation with level of TNF-Alpha and total antioxidant capacity (TAC) in patients undergoing routine hemodialysis. This study enrolled 120 routine hemodialysis patients at hemodialysis unit RSUP Dr. Hasan Sadikin Bandung Indonesia from March-April 2019 who met inclusion and exclusion criteria. Malnutrition inflammation score (MIS) assessment was using standard forms and criteria. While the level of TNF-Alpha and TAC were measured using ELISA method with serum drawned from patients just before hemodialysis. Data were analyzed by calculating distribution frequency, while the correlation between nutritional status (MIS value) and levels of TNF-Alpha and TAC were analyzed using Rank Spearman analysis (p<0,05). Of the 120 patients enrolled in this study, 97 (80.8%) patients had good nutritional status (MIS value ≤ 6) and 23 (19.2%) had poor nutritional status (MIS value > 6). Bivariate analysis showed no significant correlation between MIS with TNF-Alpha levels (r = -0.042, p = 0.650 ), neither between MIS with total antioxidant capacity (TAC) levels ( r = 0.087, p = 0.344 ). Interestingly, there was a strong positive correlation between TNF-alpha and TAC in specifically malnutrition-inflammation patients with MIS > 6 (r= 0.508; p=0.007*) but there was no correlation between TNF-alpha and TAC in good nutrition patients with MIS ≤ 6 (r=0.043 ; p= 0.339). There are still enough patients who underwent routine HD with malnutrition. In this study, there were no significant correlation between MIS value with TNF-Alpha levels, and neither with total antioxidant capacity (TAC). Strong positive correlation showed between TNF-alpha and TAC in patients with MIS > 6 that showed higher inflammation and poor nutrition.