Dialysis Malnutrition and Malnutrition Inflammation Scores: screening tools for prediction of dialysis – related protein-energy wasting in Malaysia

透析营养不良和营养不良炎性评分：在马来西亚预测透析相关的蛋白质-能量消耗的筛选工具

Gilcharan Singh Harvinder ； Winnie Chee Siew Swee ； Tilakavati Karupaiah ； Sharmela Sahathevan ； Karuthan Chinna ； Ghazali Ahmad ； Sunita Bavanandan ； Bak Leong Goh

《Asia Pacific Journal of Clinical Nutrition》 25卷1期 (2016/01) Pp. 26-33

https://doi.org/10.6133/apjcn.2016.25.1.01

摘要

背景与目的：在马来西亚透析患者中，营养不良的发生率很高，需要一种能够早期识别和管理患者的有效的筛查工具。本横断面研究目的是在马来西亚透析患者中探讨透析营养不良评分工具（DMS）和营养不良炎症评分工具（MIS）预测蛋白质能量消耗（PEW）的敏感度。方法与研究设计：用DMS和MIS筛查155名血液透析（HD）和90名腹膜透析（PD）患者营养不良的风险，并与国际肾脏营养与代谢协会（ISRNM）已经制定的PEW指南进行比较。结果：MIS截点得分≥5表示所有的患者存在营养不良。根据ISRNM标准，59%的HD和83%的PD患者有PEW。基于DMS，73%的HD和71%的PD患者存在中度营养不良，而使用MIS，分别有88%和90%的患者为营养不良。在HD（R2=0.552，p＜0.001）和PD（R2=0.466，p＜0.001）患者中，DMS和MIS显著相关。与HD患者相比（分别为59%和60%），PD患者对DMS和MIS有较高的灵敏度值（分别为81%和82%）。结论：在马来西亚透析患者中，确定了MIS区分营养不良的截点值（得分≥5）。对于透析患者，尤其是接受腹膜透析的患者，DMS和MIS是有效的营养筛查工具。DMS可能是用在马来西亚透析装置中更实用更简单的工具，因为它不需要实验室指标。

關鍵字

蛋白质-能量营养不良 ； 营养评估 ； 透析 ； 透析营养不良评分 ； 营养不良炎症评分

並列摘要

Background and Objectives: Malnutrition is highly prevalent in Malaysian dialysis patients and there is a need for a valid screening tool for early identification and management. This cross-sectional study aims to examine the sensitivity of the Dialysis Malnutrition Score (DMS) and Malnutrition Inflammation Score (MIS) tools in predicting protein-energy wasting (PEW) among Malaysian dialysis patients. Methods and Study Design: A total of 155 haemodialysis (HD) and 90 peritoneal dialysis (PD) patients were screened for risk of malnutrition using DMS and MIS and comparisons were made with established guidelines by International Society of Renal Nutrition and Metabolism (ISRNM) for PEW. Results: MIS cut-off score of ≥5 indicated presence of malnutrition in all patients. A total of 59% of HD and 83% of PD patients had PEW by ISRNM criteria. Based on DMS, 73% of HD and 71% of PD patients exhibited moderate malnutrition, whilst using MIS, 88% and 90%, respectively were malnourished. DMS and MIS correlated significantly in HD (r^2=0.552, p＜0.001) and PD (r^2=0.466, p＜0.001) patients. DMS and MIS had higher sensitivity values in PD (81% and 82%, respectively) compared to HD (59% and 60%, respectively) patients. Conclusions: The MIS cut-off scores for malnutrition classification were established (score ≥5) for use amongst Malaysian dialysis patients. Both DMS and MIS are valid tools to be used for nutrition screening of dialysis patients especially those undergoing peritoneal dialysis. The DMS may be a more practical and simpler tool to be utilized in the Malaysian dialysis settings as it does not require laboratory markers.

並列關鍵字

protein-energy malnutrition ； nutritional assessment ； dialysis ； Dialysis Malnutrition Score ； Malnutrition Inflammation Score