Abstract
PurposeMalnutrition is prevalent in patients on dialysis and is associated with morbidity and mortality. Nutritional status can be assessed by a variety of biochemical and physical parameters or nutritional assessment scores. Most of these methods are expensive or cumbersome to use and are not suitable for routine repetitive follow-up in dialysis patients. The Mini Nutritional Assessment (MNA) has a short form screening set (MNA-SF), which would be suitable as a screening tool, but has not been validated yet in dialysis patients. We aimed to assess whether the MNA is an appropriate tool for identifying nutritional problems in dialysis patients.MethodMNA, routine biochemistry, physical parameters, comorbidities were assessed in cross-sectional multicentric cohorts of hemodialysis and peritoneal dialysis patients with a longitudinal follow up of 2 years for mortality.ResultsIn this cohort of 216 patients, mortality was 27.3% at a follow up of 750±350 days. The mean MNA-SF score was 9.9±1.8, with 30.1%, 59.3% and 10.6% of patients categorized as having normal nutritional status, at risk for malnutrition and malnourished, respectively. The screening score was associated with mortality (HR 0.86, 95% CI 0.75–0.98 per point). With normal nutrition as reference, adjusted mortality was 2.50 (95% CI 1.16–5.37) and 3.89 (95% CI 1.48–10.13) for patients at risk for malnutrition and with malnutrition, respectively. After recalibrating the MNA full score for the specificity of some of its domains for dialysis patients, the MNA-SF had a good sensitivity and specificity for not being well nourished (0.95 and 0.63 respectively) in the full score, and a high negative predictive value (0.91).ConclusionThe MNA-SF is independently associated with 2 year mortality in dialysis patients. It has a high negative predictive value for excluding being at risk or having malnutrition in the full score. Therefore, it can be advocated as a screening tool for nutritional status in dialysis patients.
Highlights
Malnutrition is an important and prevalent problem affecting 16% to 70% of dialysis patients, depending on the study population and assessment procedure [1,2,3]
The mean Mini Nutritional Assessment (MNA)-SF score was 9.9±1.8, with 30.1%, 59.3% and 10.6% of patients categorized as having normal nutritional status, at risk for malnutrition and malnourished, respectively
The screening score was associated with mortality (HR 0.86, 95% confidence intervals (CI) 0.75–0.98 per point)
Summary
Malnutrition is an important and prevalent problem affecting 16% to 70% of dialysis patients, depending on the study population and assessment procedure [1,2,3]. An adequate nutritional assessment tool should meet several essential criteria: (1) diagnose malnutrition accurately, (2) detect changes in nutritional status over time, (3) be associated with morbidity and mortality and (4) evaluate the impact of a nutritional intervention [9]. According to the instructions of the MNA score, no further evaluation by the full score is needed when patients are rated as “normal nutrition” by the MNA-SF, as the score has a high negative predictive value for malnutrition. This makes the tool ideally suited for rapid screening, as would be the case for regular followup in dialysis patients. Validation and eventual recalibration of the MNA score in a dialysis cohort is necessary
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