Association between malnutrition-inflammation score (MIS) and quality of life in elderly hemodyalisis patients

Lemos, Kelly Cristiane Rocha; Garcia, Anália Nusya de Medeiros; Santos, Thais Oliveira Claizoni dos; Vieira, Nathalia Fidelis Lins; Santos, Ana Célia Oliveira dos

doi:10.1590/2175-8239-JBN-2023-0171en

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Brazilian Journal of Nephrology

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Original Article • Braz. J. Nephrol. 46 (4) • Oct-Dec 2024 • https://doi.org/10.1590/2175-8239-JBN-2023-0171en copy

Association between malnutrition-inflammation score (MIS) and quality of life in elderly hemodyalisis patients

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

The malnutrition-inflammation process is one of the main causes of morbidity and mortality in patients with chronic kidney disease (CKD), influencing quality of life. The aim of this study was to identify the inflammatory and nutritional status of elderly hemodialysis (HD) and its association with quality of life.

Methods:

This study was carried out in health services in three different cities. The Malnutrition-Inflammation Score (MIS) was used to assess the inflammatory and nutritional status, with anthropometric measurements, protein status, lean mass and function. The quality of life was assessed using KDQOL-SF^TM. Data were analyzed using multivariate analysis and the Poisson model to evaluate the factors that increased the risk of developing malnutrition and inflammation.

Results:

The MIS identified a 52.2% prevalence of malnutrition and inflammation in the population. In univariate analysis, most KDQOL-SF^TM domains presented higher scores for nourished elderly. Anthropometric measures associated with muscle mass and functionality were lower in the malnourished elderly. Multivariate modeling revealed a higher nutritional risk of 50.6% for women and older age, since with each additional year of life the risk of malnutrition increased by 2.4% and by 0.4% with each additional month on HD. Greater arm muscle circumference (AMC) and higher serum albumin were factors for reducing malnutrition by 4.6% and 34.7%, respectively.

Conclusion:

Higher serum albumin and preserved AMC have been shown to be good indicators of better nutritional status. Higher MIS was associated with poorer quality of life, older age, lower income and education, longer time on dialysis, and presence of comorbidities.

Keywords:
Malnutrition; Dialysis; Chronic Kidney Insufficiency; Elderly; Quality of Life

		Malnutrition-inflammation score (MIS)
Characteristics	Total^* Notes: *Absolute and relative frequency for categorical variables;	Nourished (MIS < 6)^* Notes: *Absolute and relative frequency for categorical variables;	Malnourished (MIS = 6)^* Notes: *Absolute and relative frequency for categorical variables;	p-value
	(n = 207)	(n = 99)	(n = 108)
Age (years)^ Mean ± SD;	68.23 ± 6.68	66.80 ± 4.96	69.55 ± 7.72	0. 002 ¹ 1p-value of Student’s t-test;
Sex
Female	76 (36.7)	24 (31.6)	52 (68.4)	< 0. 001 ³ 3p-value of Chi-square test;
Schooling
< 9 years (low schooling)	113 (54.6)	55 (48.7)	58 (51.3)	0.789³ 3p-value of Chi-square test;
Civil status (with partner)
No partner	73 (35.3)	28 (38.4)	45 (61.6)	0.044 ³ 3p-value of Chi-square test;
Family income
< 1 minimum wage	4 (1.9)	2 (50)	2 (50)	0.921³ 3p-value of Chi-square test;
1–5 minimum wages	188 (90.8)	89 (47.3)	99 (52.7)
> 5 minimum wages	15 (7.2)	8 (53.3)	7(46.7)
Nutritional Parameters
BMI (kg/m²)^ Mean ± SD;	24.29 ± 4.21	25.22 ± 3.94	23.43 ± 4.28	0.002 ¹ 1p-value of Student’s t-test;
AC (cm)^ Mean ± SD;	28.10 ± 3.82	29 ± 3.32	27.29 ± 4.07	0.001 ¹ 1p-value of Student’s t-test;
AMC (cm)^ Mean ± SD;	23.82 ± 2.91	24.66 ± 2.47	23.04 ± 3.08	< 0.001 ¹ 1p-value of Student’s t-test;
CC (cm)^ Mean ± SD;	32.47 ± 3.38	33.43 ± 3.13	31.59 ± 3.38	< 0.001 ¹ 1p-value of Student’s t-test;
HGS (kg)^ Mean ± SD;	24.29 ± 8.73	27.10 ± 8.82	21.71 ± 7.85	<0.001 ¹ 1p-value of Student’s t-test;
Serum albumin (g/dL)^ Mean ± SD;	3.8 ± 0.33	3.86 ± 0.30	3.74 ± 0.34	0.008 ¹ 1p-value of Student’s t-test;
Comorbidities
Diabetes mellitus	100 (48.3)	47 (47)	53 (53)	0.818³ 3p-value of Chi-square test;
Systemic arterial hypertension	180 (87)	84 (46.7)	96 (53.3)	0.389³ 3p-value of Chi-square test;
Anemia	97 (46.9)	41 (42.3)	56 (57.7)	0.163³ 3p-value of Chi-square test;
Dialysis Parameters
Dialysis dose (Kt/V)^ Mean ± SD;	1.58 ± 0.36	1.52 ± 0.32	1.64 ± 0.38	0.014 ¹ 1p-value of Student’s t-test;
Phosphorous (mg/dL)^ Mean ± SD;	4.84 ± 1.11	4.91 ± 1.08	4.77 ± 1.15	0.373¹ 1p-value of Student’s t-test;
Calcium (mg/dL)^ Mean ± SD;	8.87 ± 0.66	8.93 ± 0.68	8.82 ± 0.63	0.246¹ 1p-value of Student’s t-test;
Calcium-phosphorus product (mg²/dL²)^ Mean ± SD;	42.29 ± 10.89	43.27 ± 10.57	41.39 ± 11.14	0.214¹ 1p-value of Student’s t-test;
PTH (pg/ mL)^* *Median and interquartile range;	311.30 (168; 493)	338.10 (173; 519)	298.25 (165.25; 460)	0.454² 2p-value of Mann-Whitney test;
Vitamin D (ng/mL)^ Mean ± SD;	31.88 ± 12.35	33.20 ± 13.11	30.68 ± 11.53	0.144¹ 1p-value of Student’s t-test;
Hemoglobin (g/100 ml)^ Mean ± SD;	10.98 ± 1.4	11.09 ± 1.45	10.87 ± 1.45	0.271¹ 1p-value of Student’s t-test;
Time on HD (months)^* *Median and interquartile range;	51 (22; 88)	43 (21; 78)	59 (24.50; 97.5)	0.041 ² 2p-value of Mann-Whitney test;
Vascular access for HD
AVF or prosthetic	154 (74.4)	74 (48.1)	80 (51.9)	0.912³ 3p-value of Chi-square test;
Permcath or DLC	53 (25.6)	25 (47.2)	28 (52.8)	0.912³ 3p-value of Chi-square test;
Length of HD session
3 to 3.5 hours	8 (3.9)	4 (50)	4 (50)	1.000⁴ 4p-value of Fisher’s exact test.
4 hours	199 (96.1)	99 (47.8)	108 (52.2)	1.000⁴ 4p-value of Fisher’s exact test.

Nutritional indicator	Prevalence of malnutrition (%)
MIS (= 6)	52.2
Serum albumin (< 3.8 g/dL)	38.2
Reduced AMC (> 10%)	39.1
HGS (< 23.3 kg)	54.1
CC (< 31 cm)	30.9

		Malnutrition-Inflammation Score (MIS)
Assessed dominion	Total^ Mean ± SD;	Nourished (MIS < 6)^ Mean ± SD;	Malnourished (MIS = 6)^ Mean ± SD;	p-value
Specifics	(n = 207)	(n = 99)	(n = 108)
List of symptoms/problems	79.22 ± 15.14	83.69 ± 13.62	75.13 ± 15.36	< 0. 001 ¹ 1p-value of Student’s t-test;
Effects of kidney disease	69.38 ± 17.85	73.13 ± 16.40	65.94 ± 18.50	0.004 ¹ 1p-value of Student’s t-test;
Burden of kidney disease^* *Median and interquartile range;	50 (37.5; 75)	50 (43.75; 75)	50 (25; 62.5)	0.004 ² 2p-value of the Mann-Whitney test. In the dimensions of the KDQOL - SFTM the value 0 reflects the lowest QoL and the value 100 reflects the highest QoL.
Professional role^* *Median and interquartile range;	0 (0; 50)	0 (0; 50)	0 (0; 50)	0.413² 2p-value of the Mann-Whitney test. In the dimensions of the KDQOL - SFTM the value 0 reflects the lowest QoL and the value 100 reflects the highest QoL.
Cognitive Function	85.31 ± 17.08	89.56 ± 16.11	81.41 ± 17.07	0.001 ¹ 1p-value of Student’s t-test;
Quality of Social Interaction	80.97 ± 17.38	83.29 ± 17.85	78.82 ± 16.72	0.064¹ 1p-value of Student’s t-test;
Sexual Function^* Notes: *(n = 47);	86.17 ± 22.31	91.53 ± 15.60	75.78 ± 29.39	0.059¹ 1p-value of Student’s t-test;
Sleep	69.24 ± 21.32	73.98 ± 20.39	64.88 ± 21.30	0.002 ¹ 1p-value of Student’s t-test;
Social support	80.27 ± 28.23	84.34 ± 24.49	76.54 ± 30.91	0.045 ¹ 1p-value of Student’s t-test;
Stimulation from dialysis team	72.89 ± 27.72	76.13 ± 26.06	69.90 ± 28.95	0.106¹ 1p-value of Student’s t-test;
Patient Satisfaction	64.65 ± 22.46	69.19 ± 21.86	60.49 ± 22.27	0.005 ¹ 1p-value of Student’s t-test;
Generic (SF)
Physical Functioning^* *Median and interquartile range;	45 (25; 75)	60 (35; 85)	35(20; 58.75)	<0.001 ² 2p-value of the Mann-Whitney test. In the dimensions of the KDQOL - SFTM the value 0 reflects the lowest QoL and the value 100 reflects the highest QoL.
Role-Physical^* *Median and interquartile range;	50 (25; 100)	75 (50; 100)	25 (0; 75)	<0.001 ² 2p-value of the Mann-Whitney test. In the dimensions of the KDQOL - SFTM the value 0 reflects the lowest QoL and the value 100 reflects the highest QoL.
Pain^* *Median and interquartile range;	77.50 (42.50; 100)	80 (45; 100)	75.0 (32; 50)	0.004 ² 2p-value of the Mann-Whitney test. In the dimensions of the KDQOL - SFTM the value 0 reflects the lowest QoL and the value 100 reflects the highest QoL.
General Health^* *Median and interquartile range;	50(40; 70)	55 (45; 70)	50 (35; 65)	0.070² 2p-value of the Mann-Whitney test. In the dimensions of the KDQOL - SFTM the value 0 reflects the lowest QoL and the value 100 reflects the highest QoL.
Emotional well-being	72.37 ± 22.74	76.52 ± 23.27	68.55 ± 21.65	0.011 ¹ 1p-value of Student’s t-test;
Role-Emotional^* *Median and interquartile range;	66.67 (0; 100)	100 (33.33; 100)	66.7 (0; 100)	0.002 ² 2p-value of the Mann-Whitney test. In the dimensions of the KDQOL - SFTM the value 0 reflects the lowest QoL and the value 100 reflects the highest QoL.
Social Function	74.52 ± 23.94	80.05 ± 22.44	69.44 ± 24.24	0.001 ¹ 1p-value of Student’s t-test;
Energy/Fatigue	62.08 ± 22.62	64.54 ± 23.86	59.81 ± 21.27	0.133¹ 1p-value of Student’s t-test;

Assessed factor	PR	95%CI	p-value
Sex
Male	1.000	–	–
Female	1.506	1.154 – 1.965	0.003
Age	1.024	1.009 – 1.040	0.002
AMC	0.954	0.913 – 0.998	0.042
Albumin	0.653	0.452 – 0.943	0.023
Time on HD (months)	1.004	1.002 – 1.006	<0.001

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[1] Correspondence to: Ana Célia Oliveira dos Santos. Email: ana.oliveira@upe.br