Risk Stratification of Hemodialysis Patients with Protein-Energy Wasting Using Hand Grip Strength and Malnutrition-Inflammation Score: are Two Indices Better than One?

Document Type : Original Article


1 Associate Professor of Nutrition, Physiology Research Center, Institute of Basic and Clinical Physiology & Department of Nutrition, Faculty of Health, Kerman University of Medical Sciences, Kerman, Iran

2 Associate Professor of Occupational Health, Department of Occupational Health, Faculty of Health, Kerman University of Medical Sciences, Kerman, Iran

3 Professor of Biostatistics, Research Center for Modeling in Health, Institute for Future Studies in Health, Department of Biostatistics and Epidemiology, Faculty of Health, Kerman University of Medical Sciences, Kerman, Iran

4 Associate Professor of Nephrology, Department of Nephrology and Renal Transplantation, Afzalipour Hospital & Physiology Research Center, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran

5 Master of Occupational Health, Department of Occupational Health, Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran


Background: We aimed to detect whether risk stratification of hemodialysis (HD) patients with a combination of both malnutrition-inflammation score (MIS) and hand grip strength (HGS) indices identified more precisely patients at increased risk of protein-energy wasting (PEW).
Methods: This was a deductive-analytical cross-sectional study. We determined the HGS and MIS of 83 HD patients who were randomly selected from the dialysis centers in Kerman. Data were analyzed using t-tests and One-way ANOVA. Multinomial logistic regression and receiver operating characteristic (ROC) curve analysis were performed accordingly.
Results: There were significant differences between normal and high risk MIS regarding gender, having diabetes mellitus (DM), duration of dialysis, serum albumin, and C-reactive protein (p = 0.021, 0.049, 0.003, 0.038, and 0.027, respectively). There were also significant differences between normal and high risk HGS groups regarding age, having DM, cause of kidney disease (DM and/or hypertension), creatinine level, total cholesterol, weight, height, and mid upper arm circumference (p = 0.000, 0.006, 0.024, 0.011, 0.044, 0.026, 0.014, and 0.029, respectively). The ROC curves of the MIS and HGS indices showed sensitivity and specificity of 89.7% and 93.8%; 78.0% and 72.5%; respectively.
Conclusions: Our findings reveal that patients, defined as “normal by both”, “normal by either”, and/or “high risk by both” based on the diagnostic tools, exhibit different markers compared to patients categorized by either index separately. The cutoff of MIS for the occurrence of PEW varied depending on the procedure used. The sensitivity and specificity of MIS and HGS indices were excellent.


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