Malnutrition screening tool, MNA-SF, significantly predicts mortality in elderly patients with maintenance hemodialysis

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  • 栄養障害スクリーニング法mini nutritional assessment short form (MNA-SF) と高齢血液透析患者の生命予後の関連
  • エイヨウ ショウガイ スクリーニングホウ mini nutritional assessment short form (MNA-SF)ト コウレイ ケツエキ トウセキ カンジャ ノ セイメイ ヨゴ ノ カンレン

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Abstract

Nutritional assessment and active intervention for malnutrition in patients with hemodialysis are recommended because malnutrition makes the clinical outcome worse. We examined the association between mini nutritional assessment short form (MNA-SF) and mortality in elderly patients with hemodialysis, by comparisons of malnutrition-inflammation score (MIS) and geriatric nutrition risk index (GNRI). Eighty-two patients aged ≥65 who had received hemodialysis for ≥6 months were rated with MNA-SF, MIS, and GNRI by dietitians. Cases with MNA-SF <12, MIS ≥6, and GNRI <91.2 were defined as at risk of malnutrition. All cause death was prospectively examined for 2 years. The score of MNA-SF was significantly correlated with MIS (ρ=−0.660, p<0.001) and GNRI (ρ=0.482, p<0.001). According to MNA-SF, MIS, and GNRI, 55%, 59%, and 35% of the patients were classified as at risk of malnutrition, respectively. During the follow-up period, 14 patients (17%) died. Relative mortality risks of each group were 10.7 (p=0.002), 2.6 (p=0.137), and 4.6 (p=0.004), respectively. Although the score by each method significantly predicted death in receiver operating characteristic analysis, area under the curve of MNA-SF was the largest (0.829, 95% confidence interval 0.723-0.935). Logistic analysis revealed that food intake (p=0.048) and neuropsychology (p=0.005) in MNA-SF and food intake (p=0.033) and functional capacity (0.035) in MIS were significantly associated with survival. Our study showed that MNA-SF was a significant predictor of mortality and was better than MIS or GNRI. MNA-SF should be a useful screening tool for malnutrition in elderly patients with hemodialysis.

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