Skip to main content Skip to main navigation menu Skip to site footer

Role of malnutrition inflammation score and interleukin-6 on quality of life of regular hemodialysis patients

  • Ni Wayan Sri Wardani ,
  • I Gde Raka Widiana ,
  • Yenny Kandarini ,


Background: Malnutrition, systemic inflammation, and atherosclerosis known as MIA syndrome occurs in patients who have undergone regular hemodialysis (HD) and can lower their quality of life (QoL). Current study aimed to determine the interrelation of malnutrition and inflammation to QoL.

Methods: A cross-sectional analytic study was conducted in our hemodialysis installation. We performed Malnutrition Inflammation Score (MIS) and measure serum IL-6 to determine malnutrition and inflammation conditions in regular HD patients and utilized ‘Kidney Disease Quality of Life-Short Form (KDQOL-SF) to assess QoL MIS. IL-6 cut-off point were determined by the Receiver Operating Curves (ROC) then we performed linear regression to analyze the relationship level of MIS and IL-6 with level of QoL. We also used path analysis to prove the mechanism model of MIS and IL-6 to QoL on regular HD patients.

Results: This study consisted of 60 regular HD patients, 40 (66.7%) of men with mean age of 51.8 years and 78 months average of dialysis vintage. Good QoL was obtained ≥60 overall health (above the median value) and high level of MIS was obtained ≥5 with 75% sensitivity and 21.8% specificity, while high IL-6 level were ≥47.21 pg/mL, with 62.2% sensitivity and specificity of 78.3%. This study found the prevalence of protein-energy wasting (PEW) in regular HD patients was 81.7% by using high level of MIS. MIS were significantly correlated to IL-6 (r = 0.376, p = 0.003) however high level of MIS were uncorrelated to poor QoL. The mechanism of the interrelation of MIS, IL-6, and QoL showed on path analysis that MIS was 15% directly correlated to QoL, however, IL-6 indirectly correlated to QoL on regular hemodialysis patients.

Conclusion: MIS and IL-6 were correlated to QoL and MIS also correlated to IL-6. Malnutrition inflammatory score directly affected QoL but IL-6 indirectly affected QoL in regular HD patients.


  1. Prasad N, Jha V. Hemodialysis in Asia. Kidney Dis. 2015;1(3):165–77.
  2. PERNEFRI. 10th Report Of Indonesian Renal Registry 2017 10 th Report Of Indonesian Renal Registry 2017; 2018.
  3. Rao P, Reddy GC, Kanagasabapathy AS. Malnutrition-inflammation- atherosclerosis syndrome in chronic kidney disease. Indian J Clin Biochem. 2008;23(3):209–17.
  4. González-Ortiz AJ, Arce-Santander CV, Vega-Vega O, Correa-Rotter R, Espinosa-Cuevas MA. Assessment of the reliability and consistency of the Malnutrition Inflammation Score (MIS) in Mexican adults with chronic kidney disease for diagnosis of protein-energy wasting syndrome (PEW). Nutr Hosp. 2015;31 (33):1352–8.
  5. Pecoits-Filho R, Lindholm B, Axelsson J, Stenvinkel P. Update on interleukin-6 and its role in chronic renal failure. Nephrol Dial Transplant. 2003;18(6):1042–5.
  6. Liu Y1 et al. Association between cholesterol level and mortality in dialysis patients: role of inflammation and malnutrition. JAMA Netw. 2004;291(4):451–9.
  7. Ghiasi B, Sarokhani D, Dehkordi AH, Sayehmiri K, Heidari MH. Quality of Life of patients with chronic kidney disease in Iran: Systematic Review and Meta-analysis. Indian J Palliat Care. 2018;24(1):104-111.
  8. Raka Widiana I. Aplikasi Analisis Jalur pada Penelitian Kedokteran. In: Atmaja J, editor. Statistik Kausal dalam Penelitian Kedokteran. I. Denpasar: Udayana University Press; 2015. p. 121–48.
  9. Bokyoung JK, Park KK, Park JCJSS, Kim CKY. Health-related quality of life with KDQOL-36 and its association with self-efficacy and treatment satisfaction in Korean dialysis patients. Qual Life Res. 2013;22:753–8.
  10. Su H, Lei CT, Zhang C. Interleukin-6 signaling pathway and its role in kidney disease: An update. Front Immunol. 2017;8:1–10.
  11. Widiana IGR, Kandarini Y, Suardana IK, Suka N. Terapi Dialisis. 2nd ed. Denpasar: Udayana University Press; 2020. p. 164–76.
  12. Bossola M, Di Stasio E, Giungi S, Rosa F, Tazza L. Fatigue is associated with serum interleukin-6 levels and symptoms of depression in patients on chronic hemodialysis. J Pain Symptom Manage. 2015;49(3):578–85.
  13. Grunfeld C, Zhao C, Fuller J, Pollock A, Moser A, Friedman J, et al. Endotoxin and Cytokines Induce Expression of Leptin, the ob Gene Product, in Hamsters. J Clin Invest. 1996;9(5):2152–7.
  14. Rambod M, Bross R, Zitterkoph J, Benner D, Pithia J, Colman S, et al. Association of Malnutrition-Inflammation Score with Quality of Life and Mortality in Maintenance Hemodialysis Patients: a 5Year Prospective Cohort Study. Am J Kidney Dis. 2009;53((2)):298–309.
  15. Sohrabi Z, Eftekhari MH, Eskandari MH, Rezaeianzadeh A, Sagheb MM. Malnutrition-Inflammation Score and Quality of Life in Hemodialysis Patients: Is There Any Correlation? Nephrourol Mon. 2015;7(3).
  16. Fernandez-Real JM, Vayreda M, Richart C, Gutierrez C, Broch M, Vendrell J, et al. Circulating interleukin 6 levels, blood pressure, and insulin sensitivity in apparently healthy men and women. J Clin Endocrinol Metab. 2001;86(3):1154–9.
  17. Bacci MR, Adami F, Figueiredo FWS, Alves BCA, Da Veiga GL, Fonseca FLA. Quality of life on hemodialysis and inflammation: A descriptive analysis. Brazilian J Med Biol Res. 2018;51(6):1–7.
  18. Yamada K, Furuya R, Kumagai H, Ohkawa S, Takita T, Maruyama Y, et al. Simplified nutritional screening tools for patients on maintenance hemodialysis. Am J Clin Nutr. 2018;87(1):106–13.

How to Cite

Wardani, N. W. S., Widiana, I. G. R., & Kandarini, Y. (2022). Role of malnutrition inflammation score and interleukin-6 on quality of life of regular hemodialysis patients. Bali Medical Journal, 11(1), 545–550.




Search Panel

Ni Wayan Sri Wardani
Google Scholar
BMJ Journal

I Gde Raka Widiana
Google Scholar
BMJ Journal

Yenny Kandarini
Google Scholar
BMJ Journal