The Comparison Of MQSGA And MIS For The Evaluation Of Malnutrition-Inflammation Status And Its Impact On Quality Of Life In Maintenance Hemodialysis Patients

Objective:To study the evaluation of malnutrition-inflammation status and its impact on the quality of life in maintenance hemodialysis (MHD) patients.Methods:130 Adult patients with end stage renal disease receiving maintenance hemodialysis for more than 3 months in Yunnan Kidney Disease Hospital from January 2014 to January 2015 were included in this study.Modified-quantitative subjective global assessment(MQSGA) and malnutrition-inflammation score(MIS) were assessed by an experienced physician. We detected the indicators of malnutrition and inflammation,which including anthropometry,biochemical assays and inflammatory parameters.The body composition was also measured by bioelectrical impedance analysis.We then analyzed the correlation between MQSGA、MIS and these indicators,and compared the efficacy of MQSGA and MIS in the evaluation of malnutrition-inflammation status.Finally we used the Short Form Health Survey Questionnaire 36(SF-36) to evaluate the QoL and compared the quality of life in varying degrees of malnutrition-inflammation status,in order to analyze its impact on the quality of life in MHD patients, and explored the related factors.Results 1.general status:130 MHD patients were selected in our study:(male/female: 84/46), with an average age of 46.80±14.34 years, mean duration of dialysis was 34.88 ±31.07 months.87 patients were chronic glomerulonephritis (66.92%),18 patients were diabetic nephropathy (13.85%),18 patients were benign arteriolar nephrosclerosis (13.85%), the other 7 cases (5.38%).2.The nutritional status of 130 patients:according to the criteria of MQSGA,98 patients were malnourished, the morbidity of malnutrition was 75.4%, including 95 mild to moderate malnutrition cases(73.1%),3 severe cases(2.3%). According to the standard of MIS,all patients were malnutrition,including 78 mild malnutrition cases (60%),45 moderate malnutrition cases(34.6%),and 7 severe cases(5.4%).3.The comparison of MQSGA and MIS in the evaluation of malnutrition-inflammation status:MQSGA and MIS were negatively correlated with the nutritional indicators including BMI, TSF, MAMC, albumin,ferritin, lean body mass, muscle mass, body fat content,grip strength,MIS was also negatively correlated with prealbumin; MQSGA and MIS were both positively correlated with the inflammatory markers including hs-CRP, IL-6; in addition to TSF, MIS had a higher correlation coefficient with these indicators than MQSGA(P<0.05).4.The correlation of malnutrition and inflammation makers:The linear correlation analysis between hs-CRP, IL-6, TNF-a and nutrition indicators showed that hs-CRP was negatively correlated with grip strength and prealbumin; IL-6 was negatively correlated with MAMC, albumin and prealbumin; TNF-a was negatively correlated with hemoglobin and prealbumin(P<0.05).5.The influence of Malnutrition-inflammation status on quality of life:according to the MIS score of 130 MHD patients,their malnutrition-inflammation state was divided into three groups:mild, moderate, severe group.The SF-36 score, PF, Pain, GH, EWB, SocF, Energ, physiological field, phychological field scores were different in the three groups,and there was no significant difference in the scores of RP and RE; severe group had a lower SF-36 score, PF, Pain, GH, EWB, SocF Energ, PH, MH scores than the mild group and moderate group, differences were statistically significant (P< 0.05), and there was no significant difference in RP and RE scores in the three groups (P>0.05); mild group had a higher PH score than moderate group,however, the SF-36 score, MH score and its branches were of no statistical difference.6.Analysis of the influence factors of MIS score:MIS score was positively correlated with age,duration time of dialysis,and negatively correlated with BMI.There was no connection between gender,primary disease and MIS.Among these factors,BMI had the most impact on the MIS score, then followed by age,and the dialysis time.Conclusion:1.Malnutrition and inflammation status was in prevalent in MHD patients, and they had a close relationship;2.MQSGA and MIS can both evaluate the Malnutrition-inflammation status of MHD patients,but MIS had a better correlation of the related indicators and can evaluate the Malnutrition-inflammation status and its severity better and more accurately;3.As MIS score increased, the life quality of MHD patients was lower,to improve malnutrition-inflammation status can improve the quality of life of MHD patients;4.MIS score was positively correlated with age,duration time of dialysis,and negatively correlated with BMI.Among these factors,BMI had the most impact on the MIS score, then followed by age,and the dialysis time.