Traditional cardiovascular disease risk factors including hyperlipidemia and obesity are paradoxically associated with improved survival in individuals with advanced chronic kidney disease. Such paradoxes underscore the important role of malnutrition-inflammation-cachexia syndrome in chronic kidney disease mortality and highlight the urgent need for comprehensive but practical nutritional assessment tools. In this Practice Point commentary, Rambod and colleagues discuss a recent paper by Yamada et al. that used the Malnutrition-Inflammation Score (MIS) as the 'reference standard' to validate five simplified nutritional screening tools in 422 Japanese patients on hemodialysis. The study found the Geriatric Nutritional Risk Index to be the most accurate of the simplified tools for identifying those patients on dialysis who are at nutritional risk. The commentary authors discuss Yamada et al.'s study and conclude that although the MIS has been widely used in patients undergoing maintenance dialysis, its wide utility does not automatically make it the ultimate reference standard for assessing other nutritional scoring tools.