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Table 3 Components of the malnutrition inflammation score (MIS)

From: Recent advances in the pathophysiology and management of protein-energy wasting in chronic kidney disease

Malnutrition Inflammation Score
(A) Patient’s related medical history
1- Change in end dialysis dry weight history:
0 1 2 3
No decrease in dry weight or weight loss <0.5 kg Minor weight loss (≥0.5 kg but <1 kg) Weight loss more than 1 kg but <5 % Weight loss >5 %
2- Dietary intake:
0 1 2 3
Good appetite and no deterioration of the dietary intake pattern Somewhat sub-optimal solid diet intake Moderate overall decrease to full liquid diet Hypo-caloric liquid to starvation
3- Gastrointestinal (GI) symptoms:
0 1 2 3
No symptoms with good appetite Mild symptoms, poor appetite or nauseated occasionally Occasional vomiting or moderate GI symptoms Frequent diarrhea or vomiting or severe anorexia
4- Functional capacity (nutritionally related functional impairment):
0 1 2 3
Normal to improved functional capacity, feeling fine Occasional difficulty with baseline ambulation, or feeling tired frequently Difficulty with otherwise independent activities (e.g., going to the bathroom) Bed/chair-ridden, or little to no physical activity
5- Comorbidity including number of years on dialysis:
0 1 2 3
On dialysis less than 1 year and healthy otherwise Dialyzed for 1–4 years, or mild comorbidity (excluding MCCa) Dialyzed >4 years, or moderate comorbidity (including one MCCa) Any severe, multiple comorbidity (2 or more MCCa)
(B) Physical exam (according to SGA criteria):
6- Decrease fat stores or loss of subcutaneous fat (below eyes, triceps, biceps, chest):
0 1 2 3
Normal (no change) Mild Moderate Severe
7- Signs of muscle wasting (temple, clavicle, scapula, ribs, quadriceps, knee, interosseous):
0 1 2 3
Normal (no change) Mild Moderate Severe
(C) Body mass index:
8- Body mass index: BMI = Wt (kg)/Ht2 (m)
0 1 2 3
BMI ≥20 kg/m2 BMI 18–19.99 kg/m2 BMI 16–17.99 kg/m2 BMI <16 kg/m2
(D) Laboratory parameters:
9- Serum albumin:
0 1 2 3
Albumin ≥4.0 g/dL Albumin 3.5–3.9 g/dL Albumin 3.0–3.4 g/dL Albumin <3.0 g/dL
10- Serum TIBC (total iron-binding capacity): ♣
0 1 2 3
TIBC ≥250 mg/dL TIBC 200–249 mg/dL TIBC 150–199 mg/dL TIBC <150 mg/dL
Total score = sum of above 10 components (0–30)
  1. aMCCs (major comorbid conditions) include CHF class III or class IV, full-blown AIDS, severe CAD, moderate to severe COPD, major neurological sequelae, and metastatic malignancies or s/p recent chemotherapy
  2. ♣Suggested equivalent increments for serum transferrin are: > 200 (0), 170-199 (1), 140-169 (2) and < 140 (3) mg/dL
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Renal Replacement Therapy

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