Changes in geriatric nutritional risk index and risk of major adverse cardiac and cerebrovascular events in incident peritoneal dialysis patients

Abstract

BackgroundGeriatric nutritional risk index (GNRI) is a validated nutritional assessment method, and lower GNRI values are closely associated with adverse clinical outcomes in dialysis patients. This study investigated the impact of changes in GNRI during the first year of dialysis on cardiovascular outcomes in incident peritoneal dialysis (PD) patients.MethodsWe reviewed medical records in 133 incident PD patients to determine GNRI at the start of PD and after 12 months. Patients were categorized into improved (delta GNRI > 0) and worsening/stationary (delta GNRI ≤ 0) groups. The primary outcome was major adverse cardiac and cerebrovascular events (MACCEs).ResultsDuring a mean follow-up of 51.1 months, the primary outcome was observed in 42 patients (31.6%). The baseline GNRI at PD initiation was not significantly associated with MACCEs (log-rank test, P = 0.40). However, the cumulative event-free rate was significantly lower in the worsening or stationary GNRI group than in the improved group (log-rank test, P = 0.004). Multivariate Cox analysis revealed that a worsening or stationary GNRI was independently associated with higher risk for MACCEs (hazard ratio, 2.47; 95% confidence interval, 1.15–5.29; P = 0.02). In subgroup analysis, patients with worsening or stationary GNRI were at significantly greater risk for MACCEs in both the lower (P = 0.04) and higher (P = 0.01) baseline GNRI groups.ConclusionBaseline GNRI was not associated with MACCEs, but patients with deteriorating or stationary nutritional status were at significantly greater risk for MACCEs, suggesting that serial monitoring of nutritional status is important to stratify cardiovascular risk in incident PD patients.

Association between nutritional risk index and outcomes for head and neck cancer patients receiving concurrent chemo‐radiotherapy

“…Lee et al demonstrated that chronic kidney disease patients who have worsening or unchanged geriatric NRI score at 1 year of peritoneal dialysis compared to the NRI score prior to peritoneal dialysis may be at risk for worse cardiac and cerebrovascular outcomes. 20 That study is notably different from ours not only in the cohort and outcome of interest, but also in that, the NRI change most likely reflects chronic physiological processes rather than acute reaction from the treatment itself. Thus, a study evaluating NRI continuous scores in HNC patients at pretreatment and multiple long-term posttreatment intervals and their associations with predefined clinical outcomes may be necessary to determine what the clinically significant threshold change may be (if any) and when this occurs.…”

Association of Geriatric Nutritional Risk Index with Mortality in Hemodialysis Patients: A Meta-Analysis of Cohort Studies

“…Furthermore, the combination of these variables increases their predictive values for the risk of mortality due to CVD and allcause mortality in HD patients [31]. Lee et al revealed that a worsening or stationary GNRI was independently associated with higher risk for major adverse cardiac and cerebrovascular events (MACCEs) in PD patients by multivariate cox analysis [48]. And reduced GNRI was also significantly associated with mortality and cardiovascular events in CKD patients not on dialysis treatment [40].…”

Impact of Blood or Erythrocyte Membrane Fatty Acids for Disease Risk Prediction: Focusing on Cardiovascular Disease and Chronic Kidney Disease

“…Vascular calcification (VC) reflects vascular aging in the elderly [ 102 ]. It also increases the risk of morbidity and mortality and it is commonly found, especially in patients with CKD [ 103 ].…”