Risk Stratification of Hemodialysis Patients with Protein-Energy Wasting Using Hand Grip Strength and Malnutrition-Inflammation Score: are Two Indices Better than One?

Abstract

Background: We aimed to detect whether risk stratification of hemodialysis (HD) patients with a combination of both malnutrition-inflammation score (MIS) and hand grip strength (HGS) indices identified more precisely patients at increased risk of protein-energy wasting (PEW). Methods: This was a deductive-analytical cross-sectional study. We determined the HGS and MIS of 83 HD patients who were randomly selected from the dialysis centers in Kerman. Data were analyzed using t-tests and One-way ANOVA. Multinomial logistic regression and receiver operating characteristic (ROC) curve analysis were performed accordingly. Results: There were significant differences between normal and high risk MIS regarding gender, having diabetes mellitus (DM), duration of dialysis, serum albumin, and C-reactive protein (p = 0.021, 0.049, 0.003, 0.038, and 0.027, respectively). There were also significant differences between normal and high risk HGS groups regarding age, having DM, cause of kidney disease (DM and/or hypertension), creatinine level, total cholesterol, weight, height, and mid upper arm circumference (p = 0.000, 0.006, 0.024, 0.011, 0.044, 0.026, 0.014, and 0.029, respectively). The ROC curves of the MIS and HGS indices showed sensitivity and specificity of 89.7% and 93.8%; 78.0% and 72.5%; respectively. Conclusions: Our findings reveal that patients, defined as “normal by both”, “normal by either”, and/or “high risk by both” based on the diagnostic tools, exhibit different markers compared to patients categorized by either index separately. The cutoff of MIS for the occurrence of PEW varied depending on the procedure used. The sensitivity and specificity of MIS and HGS indices were excellent.

Keywords

• hand grip strength
• hemodialysis
• malnutrition-inflammation score
• protein- energy wasting
• risk stratification