SGA, MIS still gold-standard for malnutrition detection in patients on maintenance haemodialysis

The well-established seven-point subjective global assessment (7p-SGA) and malnutrition inflammation score (MIS) remain the best methods for detecting malnutrition in maintenance haemodialysis (MHD) patients, a recent study has found.

In contrast, the recently developed Global Leadership Initiative on Malnutrition (GLIM) tool is a poor detector of malnutrition in MHD patients.

The study included two cohorts of MHD patients: one from Italy (n=121; mean age 67±16 years, 65 percent men) and one from Brazil (n=169; mean age 71±7 years, 66 percent men). GLIM was used to assess for malnutrition following its two-step approach (screening followed by clinical confirmation via phenotypic and aetiologic criteria). The 7p-SGA and MIS were used as standards.

In both the Italy (k, 0.26; p=0.003) and Brazil (k, 0.22; p=0.003) cohorts, GLIM only shared a fair agreement with the 7p-SGA, as determined by Cohen’s kappa test. The same was true for its agreement with MIS (Italy: k, 0.33; p<0.001; Brazil: k, 0.25; p=0.001).

GLIM also showed low sensitivity, as it could only detect 61 percent to 72 percent of the true positive malnourished patients in both cohorts, relative to 7p-SGA and MIS. Conversely, should GLIM be used to assess malnourishment in these cohorts, it would miss 28 percent to 39 percent of all cases.

“Considering the specific wasting characteristics that predominate in MHD, this specific patient population may not be an eligible/suitable group for applying indices and guidelines developed for the nonrenal population,” the researchers said. “Based on our findings, the well-established 7p-SGA and MIS methods may be more useful for the diagnosis of malnutrition in patients on MHD and should be preferred by clinicians.”