Publication: Development and validation of a malnutrition risk assessment scale for chronic kidney disease (CKD) patients in shaanxi province, China
No Thumbnail Available
Date
2025-01
Authors
Rui, Zhu Sheng
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Malnutrition remains a significant complication in Chronic Kidney Disease (CKD), contributing to poor clinical outcomes and reduced quality of life, yet effective tools for its early identification are limited. The current study aimed to develop and validate the Malnutrition Risk Assessment Scale (CKD-MRAS) tailored specifically for CKD patients. Conducted at Xi’an Provincial Hospital of Traditional Chinese Medicine in China, the study followed a multi-phase approach. In the first phase, initial items for the Malnutrition Knowledge, Attitude, and Practice (KAP) Scale and CKD-MRAS were formulated through semi-structured interviews (n=13). These initial items were refined using two rounds of the Delphi method, involving a panel of 15 experts. In the second phase, a pilot study involving 20 CKD patients was conducted to ensure clarity, feasibility, and relevance of the items before large-scale testing. Subsequently the Malnutrition KAP scale underwent validation in the first part, with CKD patients (n=152) participating in item analysis and exploratory factor analysis (EFA). Item analysis revealed the need to eliminate item K1 due to its low difficulty and discrimination index. EFA for the Attitude (A) and Practice (P) domains demonstrated factor loadings above the cut-off value of > 0.5, explaining 69.87% and 61.84% of the total variance, respectively. The scale exhibited strong internal consistency (Cronbach's alpha = 0.967, split-half reliability = 0.974). Confirmatory factor analysis (CFA) was conducted (n=151). The final 6-item model for the 'K' domain displayed
good fit based on several fit indices (RMSEA (90%CI) = 0.070 (0.000, 0.124), CFI=0.978, TLI=0.963, SRMR=0.061). Similarly, the 9-item model for the 'A' domain and the 10-item model for the 'P' domain exhibited excellent fit indices. The final measurement model comprised 25 items. In the second part, multivariable logistic regression identified independent risk factors for malnutrition, including Knowledge [AOR 0.719 (0.529-0.978), p=0.035], Attitude [AOR 0.875 (0.826-0.927), p<0.001], Practice [AOR 0.895 (0.847-0.946), p<0.001], monthly per capita household income [AOR 4.658 (1.489-14.566), p=0.008)], appetite [AOR 3.575 (1.602-7.978), p=0.002], and gastrointestinal status [AOR 8.174 (3.622-18.448), p<0.001]. The CKD-MRAS achieved an area under the curve of 0.925 and an overall accuracy of 92.5%. In the third part, the prevalence of malnutrition among CKD patients was found to be 33.7%, with 40.7% at risk according to the CKD-MRAS. Additionally, substantial agreement was observed between the CKD-MRAS and Nutrition Risk Screening (NRS2002) (Kappa = 0.657, p < 0.001). Malnutrition risk demonstrated a negative correlation with various dimensions of quality of life (r value ranging from -0.386 to -0.722, p < 0.001). In conclusion, the CKD-MRAS is a reliable and valid tool for assessing malnutrition risk in CKD patients, offering an opportunity for early intervention to improve patient outcomes. Further studies should explore its application in diverse populations and settings.