Concurrent and Predictive Validity of Composite Methods to Assess Nutritional Status in Older Adults on Hemodialysis

Objective: To assess the performance of subjective global assessment (SGA), malnutrition inflammation score (MIS), and mini nutritional assessment short-form (MNA-SF) in older adults on hemodialysis (HD) by evaluating their concurrent and predictive validity. Design: An observational and prospective study including older adults on HD. Setting: Six dialysis units. Subjects: We assessed 137 HD patients aged >= 60 years (71.7% male, 70.2 +/- 7.2 years). Main Outcome Measures: The nutritional status was assessed by 7-point SGA, MIS and MNA-SF, and by objective methods. Patients were followed up for 14.5 (8; 26.3) months (median and interquartile) to assess survival. Results: Protein energy wasting (PEW) was present in 63% of the patients when assessed by SGA, in 77% by MIS, and in 26% by MNA-SF. Most objective parameters of patients classified with PEW were lower (P < .05) than those from patients classified as well-nourished by SGA, MIS, and MNA-SF. In addition, the hazard of death was higher for patients classified as PEW by SGA (hazard ratio 2.63 [95% confidence interval 1.14-6.00]), MIS (5.13 [1.19-13.7]), and MNA-SF (2.53 [1.34-4.77]) in comparison to well-nourished patients. Conclusions: The prevalence of PEW varied depending on the tool applied. SGA, MIS, and MNA-SF had good concurrent and predictive validity for the assessment of nutritional status, but SGA and MIS were likely to perform better than MNA-SF. (C) 2016 by the National Kidney Foundation, Inc. All rights reserved.