Malnutrition inflammation score, avaliação subjetiva global de 7 pontos, indicadores antropométricos e força de preensão manual em pacientes com doença renal crônica e hemodiálise

Abstract

Chronic kidney disease (CKD) and hemodialysis (HD) provoke a series of alterations in a patient's nutritional state, including malnutrition. As a result, there is an evident need for nutritional evaluations using specific methods, validated to this population, which predict nutritional risks and clinical outcomes considering the disease and its treatment. Objectives: To evaluate the association of the malnutrition inflammation score (MIS) with the 7-point subjective global assessment (SGA 7p), anthropometric variables, and hand grip strength (HGS) in patients with CKD and HD; to evaluate the sociodemographic, economic, and clinical characteristics of this population; and to investigate its nutritional state according to the SGA-7p and anthropometric measures, as well as the HGS of HD patients. Case assessment and methods: This is a cross-sectional study, with a non-probabilistic sample design, and sampling by convenience and temporal saturation, carried out in the Nephrology Center in the town of Dourados. There were 116 participants with CKD who had been under HD for at least two months, aged 20 or older, from both sexes. For an anthropometric evaluation, we collected data on body weight (kg) at the end of the HD session, height, arm circumference (AC), calf circumference (CC), and the triceps skin fold (TSF). We used weight and height to calculate body mass index (BMI), and AC and TSF to calculate arm muscle area (AMA). We applied the tools ASG-7p and MIS. Sociodemographic and economic variables were found through interviews, and clinical variable were collected in the electronic records of the patient. The muscle function was evaluated using dynamometry. Statistical analyses were carried out using the software IBM SPSS Statistics (v.22, SPSS An IMB Company Chicago, IL). We calculated descriptive statistics, using the continuous variables of mean ± standard deviation, median, and minimum and maximum value. The chi-squared test (χ2) was used to verify the association between MIS and ASG-7p categories, anthropometric variables, and HGS. We applied a binary logistic regression model, using the stepwise forward method to determine the final model. The significance level for all tests was 5%. Results: We evaluated 116 patients with a median age of 58.5 (23-87) and a median period of HD of 29 (2-170) months. There was a predominance of males (68.1%), adults (57.8%), married persons (57%), with no work (90.5%), belonging to the "C" social class (53.5%). According to the SGA-7p, 25% of patients presented mild to moderate malnutrition. Nutritional risk, according to the mis, was above 5 for 40.5% of patients. The median of the MIS was 4 (0-14) points. Starting with the MIS, the sample was divided in two groups: scores ≤ 5 (n=69), showing no nutritional risk; and scores >5 (n=47), showing nutritional risk. The MIS had statistical associations with anthropometric variables (BMI, AC, TSF, AMA, and CC) and with the SGA-7p. 57.7% of patients presented low muscle strength, and 67.3% with adequate HGS were not under nutritional risk according to the MIS. The SGA-7p was the variable that explained best the MIS results (OR = 28.47; CI 95%, 6.53-124.17, p <0.001), followed by CC (OR = 3.31; CI 95%, 1.20-9.08, p <0.020), and the TSF (OR = 0.36; CI 95%, 0.17-0.75, p <0.006). Conclusion: The anthropometric measures of CC and TSF, and the SGA-7p determined the result of the MIS, showing that the likelihood of the patient presenting risk for malnutrition and inflammation are higher when these measures are decreased and there is malnutrition according to ASG-7p.