Association and predictive value of geriatric nutritional risk index, body composition, or bone mineral density in haemodialysis patients

Mizuiri, Sonoo; Nishizawa, Yuichiro; Doi, Toshiki; Yamashita, Kazuomi; Shigemoto, Kazuhiro; Usui, Koji; Arita, Michiko; Naitô, Takayuki; Doi, Shigehiro; Takao, Masaki

doi:10.1111/nep.13826

Cited by 12 publications

(10 citation statements)

References 28 publications

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“…(36) Vascular calcification further increases incidence of cardiovascular events and the related mortality. (12,13,15,17) Compared with the excess death risk in the general population with low BMD, the excess death risk is much higher in CKD patients with low BMD. A previous meta-analysis in general population suggested a 20% increased risk of all-cause mortality with per SD decrease in BMD at hip/femoral neck, whereas a 43% higher risk of all-cause mortality per SD decrease was observed in CKD patients in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, 12 studies were included in the review and meta-analysis. (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) Details of the literature search process are shown in Fig. 1.…”

Section: Characteristics Of Eligible Cohort Studiesmentioning

confidence: 99%

“…(7,10,11) In previous studies, low BMD measured by whole-body DXA was associated with increased risk of fractures and cardiovascular disease mortality in patients with ESRD and/or hemodialysis. (12)(13)(14)(15) Furthermore, previous cohort study suggested that cortical bone such as arm tended to be more strongly associated with mortality than trabecular bone in CKD patients; however, other studies indicated that BMD at hip and spine may be the optimal sites to reflect bone loss and predict survival in ESRD or hemodialysis patients. (14,16,17) The relationship between BMD at different sites and mortality risk is controversial in CKD patients.…”

Section: Introductionmentioning

confidence: 99%

“…(14,16,17) The relationship between BMD at different sites and mortality risk is controversial in CKD patients. (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) Moreover, there are still no unique recommendations on the optimal sites for interpretation of bone loss and monitoring the prognosis of CKD patients. Thus, we aimed at conducting a systematic review and metaanalysis of cohort studies to evaluate the association of BMD at various bone sites with all-cause mortality in CKD patients.…”

Section: Introductionmentioning

confidence: 99%

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Bone Mineral Density Is Inversely Associated With Mortality in Chronic Kidney Disease Patients: A Meta-Analysis

Jiang

Yan

Duan

2020

Journal of Bone and Mineral Research

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Low bone mineral density (BMD) is suggested to be associated with increased mortality in the general health population, but the relationship in chronic kidney disease (CKD) patients is still unclear. We performed a meta‐analysis to investigate the association of BMD in different sites with risk of all‐cause mortality in CKD patients. We searched PubMed, EMBASE, and Web of Science to identify eligible cohort studies that evaluated the association between BMD at different sites and risk of all‐cause mortality in CKD patients. Twelve cohort studies were identified, which included 2828 CKD patients and 1052 deaths. Compared with normal/high level of total body BMD, lower total body BMD was associated with 25% higher risk of all‐cause mortality. The pooled relative risk (RR) was 1.25 (95% confidence interval [CI] 1.09, 1.42) with little heterogeneity across studies. Regarding BMD measured at different sites, the risk of all‐cause mortality was highest for lower BMD at hip/femoral neck (pooled RR = 1.69; 95% CI 1.20, 2.40). The pooled RRs were 1.26 (95% CI 1.04, 1.53) and 1.17 (95% CI 1.00, 1.37) for lower BMD at arm and spine, respectively. Similarly, the risk of death for per SD decrease in BMD was also higher at hip/femoral neck (pooled RR = 1.43, 95% CI 1.15, 1.77) compared with arm (pooled RR = 1.03, 95% CI 1.00, 1.06) and spine (pooled RR = 1.17, 95% CI 0.98, 1.39). In conclusion, lower BMD values at hip, arm, spine, as well as the whole body are associated with increased risk of all‐cause mortality in CKD patients. The excess risk is highest for patients with lower BMD at hip/femoral neck, suggesting BMD measured at hip region may be the best indicator of mortality risk in CKD patients. © 2022 American Society for Bone and Mineral Research (ASBMR).

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Section: Discussionmentioning

confidence: 99%

“…Finally, 12 studies were included in the review and meta-analysis. (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) Details of the literature search process are shown in Fig. 1.…”

Section: Characteristics Of Eligible Cohort Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Bone Mineral Density Is Inversely Associated With Mortality in Chronic Kidney Disease Patients: A Meta-Analysis

Jiang

Yan

Duan

2020

Journal of Bone and Mineral Research

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“…Similarly, GNRI was positively correlated with BMD and negatively correlated with the incidence of osteoporosis in T2 diabetic patients ( 5 ). In hemodialysis patients, GNRI was significantly associated with BMD of the femoral neck, lumbar spine, and distal radius, and combining GNRI with traditional risk factors (age, sex, diabetes, and cardiovascular disease) accurately predicted patient mortality ( 9 ). Moreover, a low GNRI level is also considered a risk factor for decreased bone mineral density in the femoral neck in young men with rheumatoid arthritis ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

Association of geriatric nutritional risk index with the risk of osteoporosis in the elderly population in the NHANES

Huang¹,

Xiao

Wang³

et al. 2022

Front. Endocrinol.

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BackgroundOsteoporosis is common in the elderly, and malnutrition is considered a major risk factor for osteoporosis. This study investigated the relationship between the Geriatric Nutrition Risk Index (GNRI) and osteoporosis based on a large cross-sectional study of the National Health and Nutrition Examination Survey (NHANES).MethodsWe included 7405 older adults from NHANES (2005 to 2018) and divided them into the High-GNRI and Low-GNRI groups based on GNRI levels to compare the prevalence of osteoporosis among the two groups. A multi-factor logistic regression analysis was used to determine whether GNRI was an independent risk factor for osteoporosis. Spearman’s rank correlation coefficient was computed to investigate the linear relationship between geriatric nutritional risk index (GNRI) and bone mineral density (BMD) T-score. Finally, a generalized additive model (GAM) revealed whether there was a non-linear relationship between GNRI and osteoporosis.ResultsThe prevalence of osteoporosis was higher in the Low-GNRI group than those in the High-GNRI group (12.2% vs. 8.2%; P = 0.001). Similarly, the femoral neck BMD T-scores (-1.09 ± 1.42 vs. -0.91 ± 1.31; P = 0.003). However, there was no significant difference between Low-GNRI group and High-GNRI group in lumbar BMD T-scores (1.700 ± 1.69 vs 1.85 ± 1.72; P>0.05). The multi-factor logistic regression analysis identified low GNRI as an independent risk factor for osteoporosis (OR: 1.544; 95% CI: 1.179-2.022; P < 0.001). Besides, GNRI showed a positive linear correlation (P < 0.001) with femoral neck BMD T-scores in older adults, with a progressive trend towards higher BMD as GNRI increased. By contrast, there was no linear correlation between GNRI and lumbar BMD T-score (P = 0.978). Lastly, the dose response curve revealed the non-linear negative correlation between GNRI and the risk of osteoporosis in the elderly (non-linear P < 0.001). With the increase of GNRI, the risk of osteoporosis gradually decreased, especially when GNRI was greater than 100, the downward trend was more significant.ConclusionGNRI is an independent risk factor for osteoporosis in the elderly and is negatively and non-linearly associated with the risk of osteoporosis in the elderly population.

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A simply calculated nutritional index provides clinical implications in patients undergoing transcatheter aortic valve replacement

et al. 2023

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Background Malnutrition is associated with adverse outcomes in patients with aortic stenosis. The Triglycerides × Total Cholesterol × Body Weight Index (TCBI) is a simple scoring model to evaluate the status of nutrition. However, the prognostic relevance of this index in patients undergoing transcatheter aortic valve replacement (TAVR) is unknown. This study aimed to evaluate the association of the TCBI with clinical outcomes in patients undergoing TAVR. Methods A total of 1377 patients undergoing TAVR were evaluated in this study. The TCBI was calculated by the formula; triglyceride (mg/dL) × total cholesterol (mg/dL) × body weight (kg)/1000. The primary outcome was all-cause mortality within 3 years. Results Patients with a low TCBI, based on a cut-off value of 985.3, were more likely to have elevated right atrial pressure (p = 0.04), elevated right ventricular pressure (p < 0.01), right ventricular systolic dysfunction (p < 0.01), tricuspid regurgitation ≥ moderate (p < 0.01). Patients with a low TCBI had a higher cumulative 3-year all-cause (42.3% vs. 31.6%, p < 0.01; adjusted HR 1.36, 95% CI 1.05–1.77, p = 0.02) and non-cardiovascular mortality (15.5% vs. 9.1%, p < 0.01; adjusted HR 1.95, 95% CI 1.22–3.13, p < 0.01) compared to those with a high TCBI. Adding a low TCBI to EuroSCORE II improved the predictive value for 3-year all-cause mortality (net reclassification improvement, 0.179, p < 0.01; integrated discrimination improvement, 0.005, p = 0.01). Conclusion Patients with a low TCBI were more likely to have right-sided heart overload and exhibited an increased risk of 3-year mortality. The TCBI may provide additional information for risk stratification in patients undergoing TAVR. Graphical abstract

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Association and predictive value of geriatric nutritional risk index, body composition, or bone mineral density in haemodialysis patients

Cited by 12 publications

References 28 publications

Bone Mineral Density Is Inversely Associated With Mortality in Chronic Kidney Disease Patients: A Meta-Analysis

Bone Mineral Density Is Inversely Associated With Mortality in Chronic Kidney Disease Patients: A Meta-Analysis

Association of geriatric nutritional risk index with the risk of osteoporosis in the elderly population in the NHANES

A simply calculated nutritional index provides clinical implications in patients undergoing transcatheter aortic valve replacement

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