MAYA YOUNG1, Dr JESSICA DAWSON1,2, Prof. IVOR KATZ1,3, KYLIE TURNER1, XIAOBING MA1, Dr MARIA CHAN1,3,4
1The St. George Hospital, Kogarah, Australia, 2University of Sydney, Camperdown, Australia, 3UNSW Sydney, Kensington, Australia, 4University of Wollongong, Wollongong, Australia
Biography:
Dr. Maria Chan (PhD, MDA, FNKF) is the Lead Renal Dietitian at the St. George Hospital, Honorary Associate Professor, University of Wollongong and Conjoint Senior Lecturer, UNSW Sydney, Australia. Maria is committed to improving the nutritional care and outcomes of patients with chronic kidney disease (CKD) globally as well as the training of renal specialist dietitians. She serves on many committees on policy setting, research, education and strategic planning. Maria’s research interest is to examine the effects of nutrition interventions on outcomes of people with CKD. She received many local and international awards for her outstanding contribution to renal nutrition.
Aim:
To determine if the Malnutrition Screening Tool (MST) accurately identifies malnutrition in outpatients with chronic kidney disease (CKD) without kidney replacement therapy (KRT)
Background:
The MST is widely used to identify people at risk of malnutrition. The MST is a poor screening tool for detecting malnutrition in the CKD inpatient setting. The presence of symptoms, e.g. poor appetite, may have greater sensitivity to identify malnutrition. Whether the MST or poor appetite, can accurately identify malnutrition risk in outpatients with CKD without KRT has not been evaluated.
Methods:
A single site retrospective audit of outpatient with CKD G4-5 (eGFR ≤30ml/min/1.732) without KRT was conducted from April 2020-March 2025. Outpatients who had an MST and a nutritional assessment using the 7-point Subjective Global Assessment (SGA) within 7-days were included. The presence of poor appetite was extracted from concurrent Integrated Palliative Care Outcome Scale-renal surveys. Sensitivity, specificity and receiver operating curve-area under the curve (ROC-AUC) analyses compared MST and poor appetite, against SGA-defined malnutrition.
Results:
Of 231 patient records, 68.8% male, median age of 69 years (IQR 58-76), median eGFR 15ml/min/1.732 (IQR 12-18). 30.0% of patients were at risk of malnutrition (MST ≥2) and 33.7% were malnourished (7-point SGA ≤5). MST had a sensitivity of 47.4% (95% CI 36.6%-58.5%), specificity of 79.1% (CI 72.2%-85.0%) and an AUC of 67.5% (CI 60.0%-75.0%). Poor appetite had a sensitivity of 51.4% (CI 39.9%-62.7%), specificity of 75.2% (CI 67.7%-81.7%) and an AUC of 63.3% (CI 52.2%-71.3%).
Conclusions:
MST and poor appetite demonstrate suboptimal sensitivity for detecting malnutrition in outpatients with CKD G4-5 without KRT. Screening tools with higher sensitivity are needed to improve the early identification of malnutrition in this cohort.
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