Evaluation of the Malnutrition-Inflammation Score in Kidney Transplant Recipients

Molnar, Miklos Zsolt; Keszei, Andras; Czira, Maria Eszter; Rudas, Anna; Ujszaszi, Akos; Haromszeki, Bela; Kosa, Janos Pal; Lakatos, Peter; Sarvary, Eniko; Beko, Gabriella; Fornadi, Katalin; Kiss, Istvan; Remport, Adam; Novak, Marta; Kalantar-Zadeh, Kamyar; Kovesdy, Csaba P.; Mucsi, Istvan

doi:10.1053/j.ajkd.2010.02.350

« Previous Next »American Journal of Kidney Diseases
Volume 56, Issue 1 , Pages 102-111, July 2010

Evaluation of the Malnutrition-Inflammation Score in Kidney Transplant Recipients

Miklos Zsolt Molnar, MD, PhD
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
- Address correspondence to Miklos Zsolt Molnar, MD, PhD, Department of Transplantation and Surgery, Semmelweis University, Baross utca 23; H-1082; Budapest, Hungary
Andras Keszei, MD, PhD
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
Maria Eszter Czira, MD
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
Anna Rudas
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
Akos Ujszaszi
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
Bela Haromszeki
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
Janos Pal Kosa
- First Department of Internal Medicine, Szent Imre Hospital, Budapest, Hungary
Peter Lakatos, MD, PhD, DSc
- First Department of Internal Medicine, Szent Imre Hospital, Budapest, Hungary
Eniko Sarvary, PhD
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
Gabriella Beko, MD
- Central Laboratory, Szent Imre Hospital, Budapest, Hungary
Katalin Fornadi, MD
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
- Department of Neurology, Semmelweis University, Szent Imre Hospital, Budapest, Hungary
Istvan Kiss, MD, PhD
- Department of Nephrology, Szent Imre Hospital, Budapest, Hungary
Adam Remport, MD
- Department of Nephrology, Szent Imre Hospital, Budapest, Hungary
Marta Novak, MD, PhD
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
- Department of Psychiatry, University Health Network, University of Toronto, Toronto, Canada
Kamyar Kalantar-Zadeh, MD, MPH, PhD
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
- David Geffen School of Medicine at UCLA, UCLA School of Public Health, Los Angeles, CA
- Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA
Csaba P. Kovesdy, MD
- Division of Nephrology, Salem VA Medical Center, Salem, VA
- Division of Nephrology, University of Virginia, Charlottesville, VA
Istvan Mucsi, MD, PhD
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
- First Department of Internal Medicine, Szent Imre Hospital, Budapest, Hungary

Received 3 October 2009; accepted 25 February 2010. published online 17 May 2010.

Background

Chronic protein-energy wasting, termed malnutrition-inflammation complex syndrome, is frequent in patients with chronic kidney disease and is associated with anemia, morbidity, and mortality in patients on maintenance dialysis therapy. The Malnutrition-Inflammation Score (MIS) recently has been developed and validated in dialysis patients.

Study Design

Observational cross-sectional study.

Setting & Participants

993 prevalent kidney transplant recipients.

Predictor

MIS computed from change in body weight, dietary intake, gastrointestinal symptoms, functional capacity, comorbid conditions, decreased fat store/Systemic Global Assessment, signs of muscle wasting/Systemic Global Assessment, body mass index, serum albumin level, and serum transferrin level.

Outcomes

Markers of inflammation and malnutrition, including serum C-reactive protein, interleukin 6, tumor necrosis factor α, serum leptin, prealbumin, body mass index, and abdominal circumference. The relationship was modeled by using structural equation models.

Results

Mean age was 51 ± 13 years, 57% were men, and 21% had diabetes. Median time from transplant was 72 months. MIS significantly correlated with abdominal circumference (r = −0.144), serum C-reactive protein level (r = 0.094), serum interleukin 6 level (r = 0.231), and serum tumor necrosis factor α level (r = 0.102; P < 0.01 for all). A structural equation model with 2 latent variables (malnutrition and inflammation factor) showed good fit to the observed data.

Limitations

Single-center study, lack of information about vascular access, presence of nonfunctioning kidney transplant, relatively high refusal rate.

Conclusions

Our results confirm that MIS reflects both energy-protein wasting and inflammation in kidney transplant recipients. This simple instrument appears to be a useful tool to assess the presence of protein-energy wasting in this patient population.

Index Words: Kidney transplant, protein-energy wasting, Malnutrition-Inflammation Score, validation