Malnutrition score and Body Mass Index as nutritional screening tools for hemodialysis patients

Malnutrition is highly prevalent in the hemodialysis population. Nutritional screening is important to identify patients at risk of malnutrition. This study aimed to investigate the concurrent validity of BMI cut-offs (BMI < 23 kg/m² and BMI < 18.5 kg/m²) and DMS, as simple nutritional screening tools, compared to PG-SGA, as the reference standard, in detecting the risk of malnutrition in hemodialysis patients.

A Single-centered cross-sectional study design.

A total of 98 patients on maintenance hemodialysis, who were at least 18 years old (mean age: 51.33 ± 14.12) and subjected to hemodialysis for at least 3 months, were screened. Concurrent validity was assessed using receiver operating characteristic (ROC) curve analysis as well as sensitivity, specificity, accuracy, PPV, NPV, LR⁺ and LR^-, against diagnosed malnutrition.

The patients considered malnourished were 71.4% (n = 70), with the majority being females (60%), and possessed a BMI distribution of 28.2 ± 6.3 kg/m². DMS (score ≥ 14) agreed with diagnosed malnutrition (κ = 0.450 (95% CI 0.26-0.64) <0.0005). Furthermore, DMS (score ≥ 14) showed a sensitivity and a specificity of 84.3% and 60.7%, respectively. However, BMI cut-offs (<23 kg/m² or < 18.5 kg/m²) did not show any agreement with diagnosed malnutrition.

DMS is a useful screening tool for detecting the risk of malnutrition in hemodialysis patients. On the contrary, BMI <23 kg/m² and BMI <18.5 kg/m² were not valid tools for identifying the risk of malnutrition in hemodialysis patients.