ISRNM criteria as a superior nutritional scoring system associated with cardiovascular events and mortality in nondialysis-dependent chronic kidney disease patients

Abstract

While protein-energy wasting (PEW) is a well-known risk factor in chronic kidney disease (CKD), its diagnosis is still controversial. We sought to compare the prevalence of PEW by three different nutritional scoring systems: 7–scale subjective global assessment (SGA), malnutrition-inflammation score (MIS), and the International Society of Renal Nutrition and Metabolism (ISRNM) criteria; and test the prognostic power of each method. This prospective study included 222 nondialysis–dependent (NDD) patients on CKD stages 2 to 5 (median age 60 [52–67] years; 63% men). MIS was graded from 0 to 30 and excluded count for dialysis vintage. SGA ≤5, MIS ≥8 and ISRNM criteria by considering 2 alterations were described as PEW. Patients were monitored for a composite outcome of cardiovascular events and mortality during 12 ± 6 months. PEW was diagnosed in 27.9% by SGA, 32.9% by MIS, 23.4% by ISRNM. Fifteen cardiovascular events and 23 deaths were registered in 30 patients. In the univariate Cox analysis, all methods predicted mortality: SGA (HR: 2.32 [1.02–5.26]), MIS (HR: 3.09 [1.31–7.34]), ISRNM (HR: 4.22 [1.85-9.62]); however, after the adjustments for age, gender, diabetes, stage of CKD, HDL cholesterol, C-reactive protein, and calcium-phosphorus product, only the ISRNM method persisted as a predictor (HR: 3.3 [1.3–8.2]). Considering the composite endpoint, only ISRNM was associated with events in both, the univariate (HR: 2.9 [1.4–5.8]) and the adjusted analysis (HR: 2.36 [1.05–5.32]). This study demonstrated that the criteria proposed by the ISRNM were the best nutritional scoring system associated with cardiovascular events and mortality in NDD chronic kidney disease patients