Developing and Validating a Renal Nutrition Screening Tool to Effectively Identify Undernutrition Risk Among Renal Inpatients

The nutrition impact symptoms (NIS) score detects malnutrition risk in patients admitted to nephrology wards

“…The NIS score had moderate inter‐rater reliability, with an intraclass correlation coefficient of 0.74, and identical NIS scores were reported between assessors in 37% of patients. Although this is less than ideal, it is significantly higher than the agreement between assessors using the R‐NST, where there same score was achieved in the repeated measure in only 8% of cases . Reliability of nutritional assessment using SGA can also be limited, with only fair inter‐rater reliability between assessors following completion of an online training package .…”

“…However, in the reliability and feasibility phase of the study, the R‐NST tool had low levels of completion by clinical staff as a result of the time taken to calculate 6‐month weight change and extract the clinical data from the electronic medical records. Reliability was difficult to measure because of the very low completion rate for nursing staff . Together, these results indicate that the R‐NST may have limited translational capacity for use in clinical practice.…”

“…With a specificity of 65%, the NIS score at a cut‐off of ≥3 was relatively effective at identifying well‐nourished patients, with similar specificity to the MST , although it does carry a reasonably high rate of false positive results. More recently, another nutrition screening tool, the R‐NST, was developed specifically for renal inpatients . The R‐NST is more complex than the NIS score, and includes biochemical parameters alongside nutrition impact symptoms and weight‐loss history.…”

“…Malnutrition is a common complication of renal disease, particularly in the later stages of chronic kidney disease (CKD). Studies demonstrate that over 50% of patients admitted to nephrology wards are malnourished , and uraemia, acidosis, dialysis and comorbidities all impact upon food intake and nutritional status in patients with kidney disease . Impaired nutritional status is associated with poor clinical outcomes, including increased morbidity, longer hospital stay, re‐admission, reduced quality of life and poorer survival .…”

“…The renal nutrition screening tool (R‐NST) was recently developed and tested for validity and feasibility . The R‐NST demonstrated high sensitivity and specificity against SGA; however, when introduced into clinical practice, there was low uptake when used by nurses, attributed to the need to access information from electronic clinical information systems, and poor agreement for scoring between researchers and nurses . Therefore, the need for a user friendly and valid nutrition screening tool for renal patients remains evident.…”