Malnutrition score and Body Mass Index as nutritional screening tools for hemodialysis patients

Abstract

Background and aims: Malnutrition is highly prevalent in the hemodialysis population. Nutritional screening is important to identify patients at risk of malnutrition. This study aimed to investigate the concurrent validity of BMI cut-offs (BMI < 23 kg/m² and BMI < 18.5 kg/m²) and DMS, as simple nutritional screening tools, compared to PG-SGA, as the reference standard, in detecting the risk of malnutrition in hemodialysis patients.

Design: A Single-centered cross-sectional study design.

Methods: A total of 98 patients on maintenance hemodialysis, who were at least 18 years old (mean age: 51.33 ± 14.12) and subjected to hemodialysis for at least 3 months, were screened. Concurrent validity was assessed using receiver operating characteristic (ROC) curve analysis as well as sensitivity, specificity, accuracy, PPV, NPV, LR⁺ and LR^-, against diagnosed malnutrition.

Results: The patients considered malnourished were 71.4% (n = 70), with the majority being females (60%), and possessed a BMI distribution of 28.2 ± 6.3 kg/m². DMS (score ≥ 14) agreed with diagnosed malnutrition (κ = 0.450 (95% CI 0.26-0.64) <0.0005). Furthermore, DMS (score ≥ 14) showed a sensitivity and a specificity of 84.3% and 60.7%, respectively. However, BMI cut-offs (<23 kg/m² or < 18.5 kg/m²) did not show any agreement with diagnosed malnutrition.

Conclusion: DMS is a useful screening tool for detecting the risk of malnutrition in hemodialysis patients. On the contrary, BMI <23 kg/m² and BMI <18.5 kg/m² were not valid tools for identifying the risk of malnutrition in hemodialysis patients.

Keywords: Body Mass Index; Dialysis malnutrition score; Hemodialysis; Patient-generated subjective global assessment; Screening.