Prognostic Value of Malnutrition-Inflammation Score in Hospitalization and Mortality on Longterm Hemodialysis

Abstract Background and Aims Since its development, cumulative evidence has been found about Malnutrition and Inflammation Score (MIS/Kalantar Score) prognostic value, however there is a shortage of recent and large studies with comprehensive statistical methodologies that contribute to support a higher level of evidence and a consensual cut-off. The aim of this study was to assess the strength of MIS association with hospitalization and mortality in a nationwide cohort. Methods Historical cohort study of HD patients from 25 outpatient centers followed-up for 48 months. Univariable and multivariable Cox additive regression models were used to analyze the data. C-index was estimated to assess the performance of the final model. Results 2444 patients were analysed, 59.0% males, 32.0% diabetic, median age of 71 years (P25=60, P75=79). During a median period of 45 months follow-up, with a maximum of 48 months (P25=31; P75=48), 875 patients presented a MIS A new cut-off point regarding the risk of death, MIS≥6, was identified for this study dataset. In multivariable analysis for hospitalization risk, a higher MIS, higher comorbidity index and arteriovenous graft or catether increased the risk, while higher Kt/V and higher albumin had a protective effect. In multivariable analysis for mortality risk, adjusting for age, albumin, nPCR, Charlson Comorbidity index, IDWG, Kt/V, diabetes, Htc, and vascular access, patients with MIS ≥6 showed an HR of 1.469 (95% CI: 1.262-1.711; p Conclusion Currently, when older patients are treated with advanced dialysis methods, MIS maintains its relevant and significant association with hospitalization and mortality.