Exploring The Concordance Of Malnutrition Assessment Tools With
The GLIM Criteria Among Hemodialysis Patients
Mirey Karavetian1, Nada Salhab2, Rana Rizk3,4, Kalliopi-Anna Poulia5
1Zayed University, Dubai, United Arab Emirates; 2Maastricht University, Maastricht, Netherlands 3Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie, The Lebanese University, Fanar, Lebanon 4Maastricht University, The Netherlands; 5Laiko General Hospital, Athens, Greece
Introduction
• Malnutrition in hemodialysis (HD) is a well-described condition, often co-existing with inflammation
• It affects 50 to 75% of HD, depending on the diagnostic tool used.
Ta Ikizler et al, Kidney International 2013
Etiology and consequences of PEW in CKD
MIS
ESPEN – GUIDELINES:Bioelectrical impedance analysis: Review of principles & methods. Clin Nutr 2004; 23: 1226-1243
Utilisation in clinical practice. Clin Nutr 2004; 23: 1430-1453
Bioelectrical Impedance Analysis
5
Correlated with
• Nutritional status
• Muscle mass
• Disease severity
Phase angle
g PhA
Reference values
Bioelectrical vector analysis, BIVA
Aim of the study
• Explore the prevalence of malnutrition using the malnutrition inflammation score (MIS) and Phase Angle (PhA)
• Compare their concordance with the new Global Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition.
Fig. 1
Clinical Nutrition DOI: (10.1016/j.clnu.2018.08.002)
Methods • Design and sample
– Cross sectional study
– Randomly recruited HD unit in United Arab Emirates
• Outcome variables
– MIS, malnourished >10
– Malnutrition assessment based on GLIM criteria
• FFMI for men <17kg/m2 , <15kg/m2
– Phase angle (PhA), derived from BIA analysis
• Statistical analysis
– Independent – test and Mann-Whitney U non parametric test, SPSS 21
– Receiver Operating Characteristic (ROC curves), Medcalc software
Results (1) N = 70 (100%)
Gender: Male 43 (61.4%)
Co morbidities
Diabetes
Hypertension
Cardiovascular Diseases
Others
46 (65.71%)
62 (88.57%)
28 (40.00%)
37 (52.86%)
Dialysis Vintage
< 1 year
1-4 years
> 4 years
5 (7.14%)
35 (50.00%)
30 (42.86%)
Results (2) Variable (N=70)
Mean (SD)
Age (years) 54.61 (12.79)
BMI (Kg/m2) 27.22 (6.48)
PhA ()¶ Phase Angle 4.66 (1.21)
MIS Malnutrition Inflammation Score 9.40 (3.07)
FMI (Kg/m2)Fat Mass Index 10.15 (5.00)
SMM Skeletal Muscle Mass(Kg) 19.67 (6.44)
Fat (Kg) 26.70 (12.57)
Median (IQR)
FFMI (Kg/m2)Fat Free Mass Index 17.09 (3.33)
FFM (Kg)Free Fat Mass 42.92 (15.14)
TBW (L)Total Body Water 32.15 (11.4)
ECW (L)Extracellular Water 15.20 (4.7)
Results (3) Prevalence of Malnutrition
Value N (% of pts)
GLIM criteria
•Stage 1, moderate
•Stage 2, severe
38 (54.29)
12 (31.58)
26 (68.62)
MIS (>10) 34 (48.57)
Concordance of GLIM with MIS (>10) and PhA (5.7o)
Criterion MIS>10 PhA5.7o
Sensitivity (%) 39.47 86.84
Specificity (%) 71.87 35.48
K value (p) 0.202
(0.089)
0.234
(0.029)
AUC 0.691 0.614
Results (4) ROC curve for PhA and MIS according to GLIM
Conclusions
• Malnutrition is highly prevalent in the HD patients studied.
• MIS performed slightly better than PhA in the diagnosis of malnutrition
when using GLIM as a reference
• Both tools may perform equally on a large sample.
• Prioritizing malnutrition screening in this population, and integrating cost-
effective, sensitive and specific tools within routine practice is essential for
this population
Thank you for your attention