Association of the erythropoiesis-stimulating agent resistance index and the geriatric nutritional risk index with cardiovascular mortality in maintenance hemodialysis patients

Abstract

Objective Hyporesponsiveness to erythropoiesis-stimulating agent (ESA) may be associated with protein-energy wasting. We investigated the relationship of the ESA resistance index (ERI) and the geriatric nutritional risk index (GNRI) for cardiovascular mortality in hemodialysis (HD) patients. Methods A total of 180 maintenance HD patients were enrolled. The patients were stratified by the GNRI of 91.2, a previously reported cut-off value, and the ERI of 13.7 (IU/week/kg/g/dL), a cut-off value for predicting cardiovascular-specific mortality, and they were classified into four groups (group 1[G1]: higher GNRI and lower ERI, G2: higher GNRI and higher ERI, G3: lower GNRI and lower ERI, G4: lower GNRI and higher ERI). Results The ERI was independently associated with the GNRI (β = −0.271, p = 0.0005). During a median follow-up of 4.6 years, higher ERI and lower GNRI were independently associated with cardiovascular mortality, respectively (adjusted hazard ratio [aHR], 3.10; 95% confidence interval [CI], 1.31–7.34, and aHR, 6.64; 95%CI, 2.60–16.93, respectively). The 7-year survival rates were 96.1%, 70.3%, 77.3%, and 50.1% in G1, G2, G3, and G4, respectively. The aHR values for G4 versus G1 were 12.63 (95%CI, 3.58–44.59). With regards to model discrimination, adding the GNRI alone, the ERI alone, and both to the traditional risk model significantly improved the net reclassification improvement by 0.421, 0.662, and 0.671, respectively. Similar results were obtained for all-cause mortality. Conclusion The ERI was independently associated with the GNRI, and could predict cardiovascular mortality in HD patients. Moreover, the combination of GNRI and ERI could improve the predictability for cardiovascular mortality.

Combined Evaluation of Geriatric Nutritional Risk Index and Modified Creatinine Index for Predicting Mortality in Patients on Hemodialysis

“…Moreover, Yamada et al recently demonstrated that the predictive accuracy of GNRI for all-cause mortality was equal to that of mCI in patients Nutrients 2022, 14, 752 2 of 9 on HD [14]. Furthermore, we recently demonstrated that a combination of GNRI and the erythropoietin resistance index or the extracellular/intracellular fluid ratio measured using bioimpedance analysis could improve the predictability of mortality risk in patients on HD [15,16].…”

“…We recently demonstrated that a combined assessment of bio-impedance analysisestimated extracellular fluid/intracellular fluid ratio and GNRI could improve the predictive accuracy for mortality in patients on HD [15]. We also reported that both the erythropoietin resistance index and GNRI were independently correlated with all-cause mortality, and the combined evaluation of these indices improved the predictability of mortality risk in this population [16]. Recently, Yamada et al showed that the GNRI and mCI were equally useful tools for predicting all-cause mortality in a patient population receiving HD [14].…”

Usefulness of computed tomography-measured psoas muscle thickness per height for predicting mortality in patients undergoing hemodialysis

“…In patients undergoing hemodialysis, muscle wasting may be partially explained by protein energy wasting 2 , a malnourished state of negative protein balance, characterized by the loss of body protein (muscle) and fuel reserves (fat) due to catabolic inflammation, which is prevalent and associated with an increased risk of mortality in this population 3 , 23 . We previously reported that high muscle mass and/or fat mass measured by bioelectrical impedance analysis are significantly associated with a decreased risk of all-cause mortality 28 . As a marker of protein energy wasting, GNRI, a simple objective nutritional assessment index that is calculated using only the serum albumin and actual/ideal body weight ratio, is widely used for patients undergoing hemodialysis 24 – 28 .…”

“…We previously reported that high muscle mass and/or fat mass measured by bioelectrical impedance analysis are significantly associated with a decreased risk of all-cause mortality 28 . As a marker of protein energy wasting, GNRI, a simple objective nutritional assessment index that is calculated using only the serum albumin and actual/ideal body weight ratio, is widely used for patients undergoing hemodialysis 24 – 28 . The SCI, determined by age, sex, single pool Kt/V for urea, and pre-dialysis serum creatinine level, is used as a surrogate marker of muscle mass or as a valuable tool for observation of nutritional status in hemodialysis patients 29 – 31 .…”

Psoas muscle index and psoas muscle density as predictors of mortality in patients undergoing hemodialysis

“…In patients undergoing hemodialysis, PEW is highly prevalent and is associated with increased risks of morbidity and mortality 3 – 6 . GNRI, which is easily calculable based on the serum albumin level and BMI, is a useful nutritional indicator to stratify the risk of PEW 22 – 26 ; therefore, our results suggest that PMI may be an indicator of PEW.…”