Objective Malnutrition is a prevalent condition in maintenance hemodialysis (MHD) patients. This study aimed to evaluate the performance of the recently developed GLIM (Global Leadership Initiative on Malnutrition) in MHD by assessing the agreement, accuracy, sensitivity, specificity, and survival prediction of GLIM when compared to 7-point subjective global assessment (7p-SGA) and malnutrition inflammation score (MIS). Design and Methods We investigated 2 cohorts: MHD_ltaly (121 adults from Italy; 67 ± 16 years, 65% men, body mass index 25 ± 5 kg/m²) and MHD_Brazil (169 elderly [age > 60 years] from Brazil; 71 ± 7 years, 66% men, body mass index 25 ± 4 kg/m²), followed for all-cause mortality for median 40 and 17 months, respectively. We applied the 2-step approach from GLIM: (1) screening and (2) confirming malnutrition by phenotypic and etiologic criteria. For 7p-SGA and MIS, a score ≤5 and ≥8, respectively, defined malnutrition. Results Malnutrition was present in 38.8% by GLIM, 25.6% by 7p-SGA, and 29.7% by MIS in the MHD_Italy cohort, and in 47.9% by GLIM, 59.8% by 7p-SGA, and 49.7% by MIS in the MHD_Brazil cohort. Cohen's kappa coefficient (κ) showed only “fair” agreement between GLIM and SGA (MHD_Italy: κ = 0.26, P = .003; MHD_Brazil: κ = 0.22, P = .003) and between GLIM and MIS (MHD_Italy: κ = 0.33, P < .001; MHD_Brazil: κ = 0.25, P = .001). Cox regression analysis showed that all 3 methods were able to predict mortality in crude analysis; however in the adjusted model, the association seemed more consistent and stronger in magnitude for 7p-SGA and MIS. Conclusion In MHD patients, GLIM showed low agreement, sensitivity, and accuracy in identifying malnourished subjects by either 7p-SGA or MIS. Considering the specific wasting characteristics that predominate in MHD, the well-established 7p-SGA and MIS methods may be more useful in this clinical setting.

Eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome) is an antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis with a frequently relapsing/refractory course.1 2 Rituximab (RTX) is an established treatment in the other ANCA-associated vasculitides, but data on EGPA are scarce.3 4 Mohammad5 reported that RTX can be effective in EGPA, particularly in ANCA-positive patients. We report the outcomes of 21 patients with EGPA who received RTX-induction (1 g 2 weeks apart, on top of ongoing immunosuppression) for refractory/relapsing disease in 2011–2017 (table 1). Starting from 2014, we scheduled RTX-maintenance (500 mg/6 months)6 7 in patients responding to RTX-induction. Nine patients received RTX-maintenance, the others received RTX only for relapses (a single, 1g infusion). Complete remission was defined as Birmingham Vasculitis Activity Score (BVAS)=0 and prednisone ≤7.5 mg/day,3 partial remission as >50% BVAS reduction and prednisone ≤15 mg/day. Refractory disease was defined as failure to achieve remission, relapse as the recurrence/new onset of clinical manifestations requiring intensification of immunosuppression or increase in glucocorticoid dose >50%.8 All patients signed informed consent; the study …