Comparison of various methods for determination of protein-energy malnutrition with subjective global assessment in hemodialysis patients

Protein-energy malnutrition (PEM) is prevalent among hemodialysis patients. So far, no study has compared various methods for determination of PEM, including subjective global assessment (SGA), dialysis malnutrition score (DMS), malnutrition inflammation score (MIS), and body mass index (BMI), in hemodialysis patients. The present study was designed to determine sensitivity, specificity, accuracy, positive and negative predictive values, as well as positive and negative likelihood ratios of DMS, MIS and BMI in comparison with SGA as the most common method for determination of PEM inhemodialysis patients. Subject and A total of 291 hemodialysis patients were randomly selected by systematic sampling from among 2302 eligible adult hemodialysis patients in Tehran hospitals. The nutritional status of the patients was assessed by completing SGA, DMS and MIS forms and determining BMI. In addition, after a 12- to 14-hour fast, 4-mL blood samples were obtained from each patient before dialysis for measurement of serum urea, creatinine, albumin and total iron binding capacity. Based on SGA, DMS, MIS, and BMI, the prevalence of mild-to-moderate PEM in Tehrani hemodialysis patients was, respectively, 60.5%, 61.5%, 54%, and 16.5%, and that of severe PEM 1%, 1.5%, 1%, and 1%. In comparison with SGA, the sensitivity, specificity, accuracy, area under the receiver operating characteristic (ROC) curve, positive and negative predictive values, and positive and negative likelihood ratios were, respectively, 94%, 88%, 92%, 97%, 93%, 92%, 7.8, and 0.07 for DMS; 87%, 96%, 91%, 97%, 97%, 83%, 22.0, and 0.13 for MIS; and 23%, 91%, 50%, 64%, 80%, 43%, 2.5, and 0.85 for BMI. The results of the present study indicate that the DMS and MIS are almost similar to SGA, in identifying malnutrition in hemodialysis patients, while BMI is not an appropriate index in this regard. In addition, it appears that the DMS is a more appropriate alternative method for SGA in routine hospital assessments.