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Bandiara R, Takaryanto D, Andhika R, Makmun A, Supriyadi R, Sukesi L. Simplified Creatinine Index as Predictor of Malnutrition in Stage 5 Chronic Kidney Disease Patients on Maintenance Haemodialysis. Int J Nephrol Renovasc Dis 2024; 17:205-213. [PMID: 39101046 PMCID: PMC11296508 DOI: 10.2147/ijnrd.s465294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 07/23/2024] [Indexed: 08/06/2024] Open
Abstract
Background Malnutrition inflammation score (MIS) is an instrument for assessing the nutritional status of stage 5 CKD patients, while simplified creatinine index (SCI) is used to assess muscle mass indirectly. Purpose This study aims to analyse the correlation between SCI and MIS, as well as determine the SCI cut-off value as a predictor of malnutrition in stage 5 CKD patients on maintenance HD. Methods This research was an analytical observational study with a cross-sectional study approach. The 132 research subjects were stage 5 CKD patients at the HD Unit of RSUP Dr. Hasan Sadikin Bandung. The research used the Rank-Spearman test with SPSS for correlative bivariate analysis. The area under the curve (AUC) on the receiver operating characteristic (ROC) curve was analysed to find the SCI cut-off value as a predictor of malnutrition in stage 5 CKD patients. Results Sixty-three subjects (47.7%) were classified as good nutrition and 69 subjects (52.3%) as poor nutrition. The average SCI value in this study was 24.5 mg/kg/day ± SD 3.2 mg/kg/day, with a median MIS value was 6. This study showed a significant negative correlation between SCI and MIS (r = -0.586, p < 0.001). The optimal SCI cut-off from the ROC curve analysis value was ≤ 24.53 mg/kg/day (sensitivity = 76.8%; specificity = 79.4%). Conclusion A negative correlation existed between SCI and MIS, with an SCI value ≤ 24.53 indicating poor nutritional status in stage 5 CKD patients on maintenance HD. SCI can be used as a predictor of malnutrition at a lower cost and easier.
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Affiliation(s)
- Ria Bandiara
- Division of Nephrology and Hypertension, Department of Internal Medicine, Padjadjaran University/Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Davin Takaryanto
- Department of Internal Medicine, Padjadjaran University/Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Rizky Andhika
- Division of Nephrology and Hypertension, Department of Internal Medicine, Padjadjaran University/Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Afiatin Makmun
- Division of Nephrology and Hypertension, Department of Internal Medicine, Padjadjaran University/Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Rudi Supriyadi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Padjadjaran University/Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Lilik Sukesi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Padjadjaran University/Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
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Cordos M, Martu MA, Vlad CE, Toma V, Ciubotaru AD, Badescu MC, Goriuc A, Foia L. Early Detection of Inflammation and Malnutrition and Prediction of Acute Events in Hemodialysis Patients through PINI (Prognostic Inflammatory and Nutritional Index). Diagnostics (Basel) 2024; 14:1273. [PMID: 38928688 PMCID: PMC11202559 DOI: 10.3390/diagnostics14121273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Protein-energy wasting and inflammation are major risk factors for complications in hemodialysis patients. As these risk factors are triggered by a pro-inflammatory state, oxidative stress and hemodynamic dysfunction, which overlap in hemodialyzed subjects, we aimed to assess the efficacy of a cost-effective and straightforward screening tool, the Prognostic Inflammatory and Nutritional Index (PINI), in regularly screening maintenance hemodialysis (MHD) patients, to detect early signs of inflammation and malnutrition. A 12-month follow-up was carried out on a cohort of 102 adult patients undergoing maintenance dialysis, during which the Prognostic Inflammatory and Nutritional Index (PINI) was calculated using the formula alpha1-Acid Glycoprotein (AGP) × C-reactive protein (CRP)/albumin (ALB) × transthyretin (TTR). A PINI score < 1 was considered normal. The patients were stratified based on their PINI score: 66 patients (64.70%) had a normal score, below 1, while 36 patients (35.30%) had a PINI score ≥ 1. Despite the absence of clinical evidence of inflammation at enrollment, the latter group exhibited higher levels of CRP. During the follow-up period, all patients with a PINI score ≥ 1 experienced at least one acute event, compared to only 6% of patients with a normal PINI score, which presented COVID-19 infection as an acute event. The evaluation of the PINI can effectively identify the silent malnutrition-inflammation syndrome and predict the risk of acute events. This straightforward test appears to be a rapid tool that is independent of the examiner's experience and subjectivity, thereby potentially reducing hospitalization costs.
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Affiliation(s)
- Monica Cordos
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.); (C.-E.V.); (A.D.C.); (M.C.B.)
| | - Maria-Alexandra Martu
- Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (V.T.); (A.G.); (L.F.)
| | - Cristiana-Elena Vlad
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.); (C.-E.V.); (A.D.C.); (M.C.B.)
| | - Vasilica Toma
- Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (V.T.); (A.G.); (L.F.)
| | - Alin Dumitru Ciubotaru
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.); (C.-E.V.); (A.D.C.); (M.C.B.)
| | - Minerva Codruta Badescu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.); (C.-E.V.); (A.D.C.); (M.C.B.)
| | - Ancuta Goriuc
- Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (V.T.); (A.G.); (L.F.)
| | - Liliana Foia
- Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (V.T.); (A.G.); (L.F.)
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Marini ACB, Schincaglia RM, Candow DG, Pimentel GD. Effect of Creatine Supplementation on Body Composition and Malnutrition-Inflammation Score in Hemodialysis Patients: An Exploratory 1-Year, Balanced, Double-Blind Design. Nutrients 2024; 16:615. [PMID: 38474743 PMCID: PMC10934827 DOI: 10.3390/nu16050615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/14/2024] Open
Abstract
Hemodialysis has a detrimental effect on fat-free mass (FFM) and muscle strength over time. Thus, we aimed to evaluate the effect of creatine supplementation on the body composition and Malnutrition-Inflammation Score (MIS) in patients with chronic kidney disease (CKD) undergoing hemodialysis. An exploratory 1-year balanced, placebo-controlled, and double-blind design was conducted with hemodialysis patients (≥18 years). The creatine group (CG) received 5 g of creatine monohydrate and 5 g of maltodextrin per day and the placebo group (PG) received 10 g of maltodextrin per day. MIS and body composition were analyzed at three time points: pre, intermediate (after 6 months), and post (after 12 months). After 6 months, 60% of patients on creatine experienced an increase in FFM compared to a 36.8% increase for those on placebo. Moreover, 65% of patients on creatine increased their skeletal muscle mass index (SMMI) compared to only 15.8% for those on placebo. Creatine increased intracellular water (ICW) in 60% of patients. MIS did not change after the intervention. In the CG, there was an increase in body weight (p = 0.018), FFM (p = 0.010), SMMI (p = 0.022). CG also increased total body water (pre 35.4 L, post 36.1 L; p = 0.008), mainly due to ICW (pre 20.2 L, intermediate 20.7 L, post 21.0 L; p = 0.016). Long-term creatine supplementation in hemodialysis patients did not attenuate the MIS, but enhanced FFM and SMMI, which was likely triggered by an increase in ICW.
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Affiliation(s)
- Ana Clara B. Marini
- Faculty of Nutrition, Federal University of Goiás, Rua 227, Quadra 68 s/n°, Setor Leste Universitário, Goiania 74605080, Brazil; (A.C.B.M.); (R.M.S.)
| | - Raquel M. Schincaglia
- Faculty of Nutrition, Federal University of Goiás, Rua 227, Quadra 68 s/n°, Setor Leste Universitário, Goiania 74605080, Brazil; (A.C.B.M.); (R.M.S.)
| | - Darren G. Candow
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK S4S 0A2, Canada
| | - Gustavo D. Pimentel
- Faculty of Nutrition, Federal University of Goiás, Rua 227, Quadra 68 s/n°, Setor Leste Universitário, Goiania 74605080, Brazil; (A.C.B.M.); (R.M.S.)
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Durbá Lacruz A, Montesa M, Molina P. [Screening and nutritional intervention in the renal patient]. NUTR HOSP 2023; 40:1117-1119. [PMID: 38047421 DOI: 10.20960/nh.05040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Introduction
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Affiliation(s)
| | | | - Pablo Molina
- Departamento de Medicina. Universitat de València
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Jacobson-Naftali M, Azoulay O, Frishman S, Godny L, Zingerman B, Rozen-Zvi B, Agur T. The Humoral Response to SARS-CoV-2 Vaccine in Hemodialysis Patients Is Correlated with Nutritional Status. Vaccines (Basel) 2023; 11:1141. [PMID: 37514958 PMCID: PMC10386095 DOI: 10.3390/vaccines11071141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
Hemodialysis patients are highly susceptible to poor nutritional status. Our objective was to investigate whether poor nutritional status during mRNA-SARS-CoV-2 vaccination is correlated with impaired vaccine responses. This retrospective study was conducted in two hospital-based dialysis units. The nutritional status of hemodialysis patients was assessed, using a malnutrition inflammation score (MIS) at the time of their first BNT162b2 vaccine dose. One month after the second vaccine dose, we performed a quantitative assessment of antibodies against the spike protein (anti-S1 IgG). A total of 115 hemodialysis patients, with an average age of 72 were enrolled in the study. Among them, 39 (33.9%) were female, and 67 (58.2%) had diabetes mellitus. In 43/115 (37.4%) patients, moderate to severe malnutrition (MIS > 5) was detected. Comparatively, malnourished patients showed a lower log-transformed mean level of anti-S1 IgG compared to those with normal nutrition (2.91 ± 0.83 vs. 3.25 ± 0.72, respectively, p = 0.024). In a multivariable analysis that adjusted for age, sex, and KT/V, the nutritional status assessed by an MIS remained inversely associated with an anti-S1 IgG response [B; -0.066 (-0.117 to -0.015)]. In conclusion, moderate to severe malnutrition in hemodialysis patients is associated with reduced humoral responses to BNT162b2 vaccination.
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Affiliation(s)
- Merav Jacobson-Naftali
- Nephrology & Hypertension Department, Rabin Medical Center, Petaḥ Tikva 4941492, Israel
- Nutrition Unit, Nephrology & Hypertension Department, Rabin Medical Center, Petaḥ Tikva 4941492, Israel
| | - Odile Azoulay
- Nephrology & Hypertension Department, Rabin Medical Center, Petaḥ Tikva 4941492, Israel
- Nutrition Unit, Nephrology & Hypertension Department, Rabin Medical Center, Petaḥ Tikva 4941492, Israel
| | - Sigal Frishman
- Nutrition Unit, Nephrology & Hypertension Department, Rabin Medical Center, Petaḥ Tikva 4941492, Israel
| | - Lihi Godny
- Nutrition Unit, Nephrology & Hypertension Department, Rabin Medical Center, Petaḥ Tikva 4941492, Israel
| | - Boris Zingerman
- Nephrology & Hypertension Department, Rabin Medical Center, Petaḥ Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Benaya Rozen-Zvi
- Nephrology & Hypertension Department, Rabin Medical Center, Petaḥ Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Timna Agur
- Nephrology & Hypertension Department, Rabin Medical Center, Petaḥ Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Boaz M, Kaufman-Shriqui V, Moore LW, Kalantar-Zadeh K. Diet Quality Index in Kidney Health and Kidney Disease. J Ren Nutr 2023; 33:1-3. [PMID: 36526157 DOI: 10.1053/j.jrn.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Mona Boaz
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel, Israel.
| | - Vered Kaufman-Shriqui
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel, Israel
| | - Linda W Moore
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Transplantation, Department of Medicine, University of California-Irvine, Irvine, California
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