MIS scoring sheet consists of four sections (patient's related medical history, physical examination, body mass index (BMI), and laboratory parameters) and 10 components. Patient's medical history consists of five components: dry weight changes, dietary intake, gastrointestinal symptoms, functional capacity, and co-morbidity, including number of years on dialysis. Major comorbid conditions (MCC) include congestive heart failure class III or IV, , severe coronary artery disease, moderate to severe chronic obstructive pulmonary disease (COPD), major neurological sequelae, and metastatic malignancies or status post recent chemotherapy. Physical examination consists of two components, which aims to detect decreased fat store or loss of subcutaneous fat and signs of muscle wasting. Laboratory parameters are serum albumin and serum total iron binding capacity (TIBC). Each of 10 MIS components is classified among four levels of severity, from 0 (normal) to 3 (severely abnormal). The sum of all 10 MIS components ranges from 0 (normal) to 30 (severely malnourished); a higher score reflects a more severe degree of malnutrition and inflammation.