Nutritional Assessment of Chronic Kidney Disease Patients Undergoing Hemodialysis Using the Nutrition Alert Form (NAF) Compared with the Malnutrition Inflammation Score (MIS) at Samutprakarn Hospital

Abstract

This quasi-experimental research aims to compare the results of using the Nutrition Alert Form (NAF) and the Malnutrition Inflammation Score (MIS) for assessing malnutrition, as well as to examine the energy and protein intake of patients from food consumed. Data were collected between February and April 2024 from 65 chronic kidney disease patients undergoing hemodialysis at Hemodialysis Centers 1 and 2, Samutprakan Hospital. Data collection methods included general health records, the NAF, MIS, 24-hour food diaries, and the Easy Dietary Assessment (EDA) for chronic kidney disease patients. Data were analyzed using descriptive statistics, ROC curve, and kappa analysis, along with Pearson and Spearman’s correlation coefficients at a 95% confidence level (p < 0.05).

The results showed that the majority of the sample were female (61.54%), and 26.15% had been on dialysis for more than 45 months. Nutritional assessments using NAF and MIS identified moderate malnutrition in 64.62% and 53.84% of patients, respectively, and severe malnutrition in 15.38% and 33.85% of patients, respectively. When using MIS as the standard, the optimal NAF cutoff score for diagnosing malnutrition was 8, with a sensitivity of 77.27% and specificity of 72.0%. The consistency of the cutoff score, as measured by Kappa and ROC curve analysis, showed an AUC ROC value of 0.747 with moderate consistency (kappa = 0.458, p < 0.001). Patients over 60 years of age had an average energy intake of 940.72 kcal per day, while those under 60 had an average of 1151.11 kcal per day. The average daily protein intake was 44.57 grams, which is 64.81% of the recommended daily intake.

          Therefore, NAF can diagnose malnutrition in patients with chronic kidney disease undergoing dialysis by using a severe malnutrition cutoff score of 8 or higher.