Association between geriatric nutritional risk index and stroke risk in hemodialysis patients: 10-Years outcome of the Q-Cohort study

Abstract

The geriatric nutritional risk index (GNRI), which is calculated using the serum albumin level and body mass index, is a nutritional marker associated with an increased risk of cardiovascular events in patients who are receiving hemodialysis. However, no studies have examined the association between the GNRI level and the incidence of stroke in this population. Methods: Three thousand forty-five patients were registered in the Q-Cohort Study, which is a multicenter, observational cohort of hemodialysis patients. The main outcomes were brain infarction and brain hemorrhage. The main exposure was GNRI levels at baseline. Patients were divided into quartiles on the basis of baseline GNRI levels: Q1, <90.7; Q2, 90.7-95.5; Q3, 95.6-99.8; Q4, >99.8. The risk of brain infarction or hemorrhage was estimated using the multivariable-adjusted Cox proportional hazard risk models and restricted cubic spline analyses.Results: During the 10-year follow-up period, 326 patients developed brain infarction and 149 patients developed brain hemorrhage. Cox proportional hazard risk models showed that the risk of brain infarction and hemorrhage in Q1 was significantly higher than that in Q4 group. The hazard ratios [95% confidence intervals] were 1.49 [1.05-2.12] and 1.89 [1.11-3.20], respectively. Restricted cubic spline curves showed that a lower GNRI was incrementally associated with an increased risk for both brain infarction and brain hemorrhage. Conclusions: Our results suggest that a lower GNRI is an independent risk factor for both brain infarction and hemorrhage in patients who are receiving maintenance hemodialysis.

Association between the geriatric nutritional risk index and the risk of stroke in elderly patients with hypertension: A longitudinal and cohort study

“…Because of its objective nature, GNRI overcomes the problems of traditional nutrition indicators, including subjective issues such as mini-nutritional assessments ( 29 ). And GNRI correlates well with malnutrition-inflammation scores and has been regarded as one of the gold standards for nutritional assessment of elderly patients with chronic diseases ( 10 , 30 ). There is evidence that patients with chronic illnesses, including chronic hemodialysis and peripheral vascular disease, have a lower GNRI ( 31 – 35 ).…”

“…The geriatric nutritional risk index (GNRI) is a simple, well-established nutrition assessment tool that uses serum albumin and body mass index (BMI) ( 9 ). Recent studies have shown that GNRI is associated with the development of atherosclerosis and an increased risk of cardiovascular mortality in older patients ( 10 , 11 ). However, studies on GNRI as a predictor of new-onset stroke are still limited.…”

“…However, studies on GNRI as a predictor of new-onset stroke are still limited. Until now, only one cohort study has reported lower GNRI in hemodialysis patients as an independent risk factor for cerebral infarction and hemorrhage, and it is unclear whether this effect can be extended to older patients with hypertension ( 10 ). Therefore, GNRI may have important clinical implications for stroke risk stratification in hypertensive patients.…”

Simplified geriatric nutritional risk index for assessing nutritional status and stratifying mortality risk in patients receiving maintenance hemodialysis

“…Accumulating evidence has shown that GNRI is a good surrogate marker of nutritional status, and that GNRI is a predictor of comorbidities and mortality in patients receiving hemodialysis or peritoneal dialysis [9–13]. A recent meta‐analysis pooled data for 10 739 patients from 19 cohort studies published between 2010 and 2018 [17].…”

“…More recently, Yamada et al [9] introduced the clinical usefulness of the GNRI in patients receiving hemodialysis as a simple tool for assessing nutritional status. Mounting evidence has shown that a lower GNRI value is closely associated with an increased risk of morbidity and mortality in patients receiving hemodialysis [10][11][12]. However, the GNRI calculation formula is a bit cumbersome and requires calculators.…”