Kidney Week

Abstract: PO2030

Performance of GLIM for Nutritional Assessment of Hemodialysis Patients: Comparison with Subjective Global Assessment (SGA) and Malnutrition-Inflammation Score (MIS)

Session Information

• Health Maintenance, Nutrition, and Metabolism: Clinical
  October 22, 2020 | Location: On-Demand
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1300 Health Maintenance, Nutrition, and Metabolism

Authors

• Avesani, Carla Maria, Karolinska institutet Department of Clinical Sciences Intervention and Technology, Huddinge, Stockholm, Sweden

Carla Maria Avesani,

• Sabatino, Alice, Parma University Hospital, Parma, Italy

Alice Sabatino,

• Guerra, Alessandro, Università degli Studi di Genova, Genova, Italy

Alessandro Guerra,

• Carrero, Juan Jesus, Karolinska Institutet, Stockholm, Stockholm, Sweden

Juan Jesus Carrero,

• Rossi, Giovanni maria, Parma University Hospital, Parma, Italy

Giovanni maria Rossi,

• Stenvinkel, Peter, Karolinska institutet Department of Clinical Sciences Intervention and Technology, Huddinge, Stockholm, Sweden

Peter Stenvinkel,

• Fiaccadori, Enrico, Parma University Hospital, Parma, Italy

Enrico Fiaccadori,

• Lindholm, Bengt, Karolinska institutet Department of Clinical Sciences Intervention and Technology, Huddinge, Stockholm, Sweden

Bengt Lindholm,

Background

There is a need for methods to identify and monitor malnutrition in maintenance hemodialysis (MHD) patients (pts). We assessed GLIM (Global Leadership Initiative on Malnutrition) and evaluated agreement and survival prediction of GLIM vs. SGA and MIS in MHD pts.

Methods

We investigated two cohorts, MHD_ltaly (121 adult pts from Italy; 67±16y, 65% men, BMI 25±5 kg/m²) and MHD_Brazil (169 elderly (age>60 y) pts from Brazil; 71±7y, 66% men, BMI 25±4 kg/m²), followed for 40 (27; 46) and 17 (12; 31) months (median and 25^th; 65^th), respectively. GLIM comprises: 1. Screening and 2. Confirming malnutrition by phenotypic and etiologic criteria. For 1., presence of >1 criteria from protein energy wasting definition was used. Pts at risk were re-tested with GLIM’s phenotypic criteria: non-volitional weight loss or low BMI (<20 kg/m² if <70y, or <22 kg/m² if <70y) and reduced muscle mass (MAMC<90%). As dialysis is a catabolic procedure, all pts were positive for the etiologic criteria. For SGA and MIS, a score ≤5 and ≧8 was considered for malnutrition, respectively.

Results

Malnutrition was present in 38.8% by GLIM, 25.6% by SGA and 29.7% by MIS in the MHD_Italy cohort, and in 47.9% by GLIM, 59.8% by SGA and 49.7% by MIS in the MHD_Brazil cohort. Cohen's kappa coefficient (κ) showed only “fair” agreement between GLIM and SGA and MIS respectively (Table). Cox regression analysis adjusted for gender and age showed that in the MHD_Italy cohort, only pts malnourished by MIS had higher risk for mortality (HR= 2.42; 95% CI 1.28 to 4.59; P=0.007) while in the MHD_Brazil cohort, pts malnourished by GLIM (HR= 2.09; 95% CI 1.13 to 3.86; P=0.02), SGA (HR= 1.96; 95% CI 1.01 to 3.79; P=0.04) and MIS (HR= 2.24; 95% CI 1.20 to 4.16; P=0.01) had higher risk for mortality.

Conclusion

In MHD pts, GLIM showed low agreement with SGA and MIS, raising question on its validity and usefulness in renal care. Only malnutrition by MIS predicted mortality risk in MHD_Italy cohort, but in the MHD_Brazil cohort, malnutrition by all three methods predicted higher mortality risk.