#2492 The GLIM classification of malnutrition in an elderly population of patients on maintenance haemodialysis
Authors: Aicardi Valeria , Tiscornia Caterina , Magatti Mariagiulia , Porcari Beatrice , Bella Giulio Pucci , Visca Sara , Tettamanti Mariagiulia , Melfa Gianvincenzo , Del Vecchio Lucia 
Published: May 2024

Abstract

Background and Aims
The prevalence of malnutrition increases with age and is common in elderly patients on haemodialysis. Malnutrition increases complications, disability, mortality, length of hospital stay and healthcare costs. The Global Leadership Initiative on Malnutrition (GLIM) classification has been proposed to define malnutrition by the combined use of aetiological (weight loss, low body mass index and reduced muscle mass on initial bioimpedentiometry and on anthropometry if bioimpedentiometry is not feasible) and phenotypic (reduced food intake and inflammation) criteria; it is still poorly validated in CKD patients.

Method
Retrospective study of 121 patients on maintenance haemodialysis aged 65 years or older (mean age 77.3 ± 6.57 years, M/F 97/24, 43.1% with diabetes) who underwent routine assessment of nutritional status by anthropometric measurements and impedentiometry. Patients also received a geriatric prognostic calculator, the Multidimensional Prognostic Index (MPI, 1, low risk, 2, moderate risk, 3, high risk) and the MNA sf as an initial nutritional screening tool. According to the GLIM criteria, patients were defined as malnourished if they had at least one phenotypic criterion. By definition, haemodialysis patients fulfil the aetiological criteria of inflammation. Therefore, we added additional aetiological criteria, including loss of food intake and/or high burden of comorbidities (third tertile of CIRS): Extended HD GLIM.

Results
The MNAsf identified 56 (46%) patients as malnourished or at risk. However, a further 21 patients had reduced muscle mass on anthropometric measurements. Given the lack of specificity of the screening in identifying patients with malnutrition in our population, all patients were considered for GLIM characterisation.
40 out of 123 (32%) patients could not undergo impedentiometry, mainly because of cardiovascular exclusion criteria. 19 of 83 (23%) patients who underwent impedentiometry had a reduced lean tissue index (LTI).
We identified 54 out of 121 (44.6%) patients who met the GLIM phenotypic criteria (4 with 3, 14 with 2 and 36 with 1 criteria).
The addition of the two phenotypic GLIM criteria to the simple assessment of muscle mass allowed the identification of 17 additional patients at risk of malnutrition.
Compared to patients without malnutrition, those fulfilling the GLIM criteria were more likely to have a higher KT/V (1.26 ± 1.39 vs. 1.39 ± 1.52, p = 0.008), lower PTH (286.7 ± 238.8 vs. 403.1 ± 215.0), lower triglycerides (125.8 vs. 48.91 vs. 159.51 ± 85.9, p+0.012), lower serum albumin (3.76 ± 0.32 vs. 3.92 ± 0.27 g/dl, p = 0.004).
In addition, patients with GLIM criteria were more likely to have a higher MPI score (0.42 ± 0.51 vs 0.31 ± 0.37, p &lt; 0.001) and to live alone or in a nursing home than with a family member or carer. Conversely, no association was found between GLIM and the presence of cognitive impairment or mobility.
38 (31.4%) patients had a loss of appetite, digestive problems, chewing or swallowing difficulties in the last 3 months. By adding this criterion and that of being in the third highest tertile of CIRS, we found that among patients fulfilling the GLIM criteria, 29/54 (37%) had enhanced aetiological criteria (Expanded HD GLIM).

Conclusion
A significant percentage of the elderly population on maintenance haemodialysis are malnourished or at high risk. The GLIM classification is a new classification with the potential to identify patients at risk earlier, before the development of sarcopenia. Malnutrition as defined by the GLIM criteria is related to the MPI outcome score.