Diagnostic validation and prognostic significance of the Malnutrition-Inflammation Score in nondialyzed chronic kidney disease patients

Nephrol Dial Transplant. 2015 May;30(5):821-8. doi: 10.1093/ndt/gfu380. Epub 2014 Dec 18.


Background: Malnutrition and inflammation are highly prevalent and intimately linked conditions in chronic kidney disease (CKD) patients that lead to a state of protein-energy wasting (PEW), the severity of which can be assessed by the Malnutrition-Inflammation Score (MIS). Here, we applied MIS and validated, for the first time, its ability to grade PEW and predict mortality in nondialyzed CKD patients.

Methods: We cross-sectionally evaluated 300 CKD stages 3-5 patients [median age 61 (53-68) years; estimated glomerular filtration rate 18 (12-27) mL/min/1.73 m(2); 63% men] referred for the first time to our center. Patients were followed during a median 30 (18-37) months for all-cause mortality.

Results: A worsening in MIS scale was associated with inflammatory biomarkers increase (i.e. alpha-1 acid glycoprotein, fibrinogen, ferritin and C-reactive protein) as well as a progressive deterioration in various MIS-independent indicators of nutritional status based on anthropometrics, dynamometry, urea kinetics and bioelectric impedance analysis. A structural equation model with two latent variables (assessing simultaneously malnutrition and inflammation factors) demonstrated good fit to the observed data. During a follow-up, 71 deaths were recorded; patients with higher MIS were at increased mortality risk in both crude and adjusted Cox models.

Conclusions: MIS appears to be a useful tool to assess PEW in nondialyzed CKD patients. In addition, MIS identified patients at increased mortality risk.

Keywords: acute phase response; outcomes; renal disease; undernutrition; uremia.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Biomarkers / metabolism
  • C-Reactive Protein / metabolism
  • Cross-Sectional Studies
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Humans
  • Inflammation / diagnosis*
  • Male
  • Malnutrition / diagnosis*
  • Middle Aged
  • Nutritional Status
  • Prognosis
  • Proportional Hazards Models
  • Renal Dialysis / adverse effects
  • Renal Insufficiency, Chronic / complications*
  • Risk Factors
  • Severity of Illness Index*


  • Biomarkers
  • C-Reactive Protein