Geriatric Nutritional Risk Index, a Simplified Nutritional Screening Index, Is a Strong Predictor of Handgrip Strength in Renal Transplant Recipients

Lin, I-Hsin; Wong, Te-Chih; Nien, Shih-Wei; Wang, Hsu-Han; Chiang, Yang‐Jen; Yang, Shumei

doi:10.1016/j.transproceed.2018.03.085

Cited by 9 publications

(4 citation statements)

References 30 publications

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“… 39 Third, lower haemoglobin levels may simply reflect general frailty and poor nutritional status, resulting in a lower muscle mass and strength. 40 The observation that KTRs with diminished haemoglobin levels have a significantly lower urinary urea excretion rate, a proxy for protein consumption, compared with KTRs with higher haemoglobin levels, supports the assumption that malnutrition might play a role. However, the association between haemoglobin levels and muscle parameters remained after adjustment for BMI and urinary urea excretion rate.…”

Section: Discussionmentioning

confidence: 79%

“…Androgenic steroids increase haematocrit as well as muscle mass 39 . Third, lower haemoglobin levels may simply reflect general frailty and poor nutritional status, resulting in a lower muscle mass and strength 40 . The observation that KTRs with diminished haemoglobin levels have a significantly lower urinary urea excretion rate, a proxy for protein consumption, compared with KTRs with higher haemoglobin levels, supports the assumption that malnutrition might play a role.…”

Section: Discussionmentioning

confidence: 92%

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Decreased haemoglobin levels are associated with lower muscle mass and strength in kidney transplant recipients

Vinke

Wouters

Stam

et al. 2022

J cachexia sarcopenia muscle

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Background Post-transplant anaemia and reduced muscle mass and strength are highly prevalent in kidney transplant recipients (KTRs). Decreased haemoglobin levels, a marker of anaemia, could adversely affect muscle mass and strength through multiple mechanisms, among others, through diminished tissue oxygenation. We aimed to investigate the association between haemoglobin levels with muscle mass and strength in KTRs. Methods We included stable KTRs from the TransplantLines Biobank and Cohort study with a functional graft ≥1 year post-transplantation. Muscle mass was assessed using 24 h urinary creatinine excretion rate (CER) and bioelectrical impedance analysis (BIA). Muscle strength was assessed with a handgrip strength test using a dynamometer and, in a subgroup (n = 290), with the five-times sit-to-stand (FTSTS) test. We used multivariable linear and logistic regression analyses to investigate the associations of haemoglobin levels with muscle mass and strength. ResultsIn 871 included KTRs [median age 58 (interquartile range (IQR), 48-66)] years; 60% men; eGFR 51 ± 18 mL/min/1.73 m 2 ) who were 3.5 (1.0-10.2) years post-transplantation, the mean serum haemoglobin level was 13.9 ± 1.8 g/dL in men and 12.8 ± 1.5 g/dL in women. Lower haemoglobin levels were independently associated with a lower CER (std. β = 0.07, P = 0.01), BIA-derived skeletal muscle mass (std. β = 0.22, P < 0.001), handgrip strength (std. β = 0.15, P < 0.001), and worse FTSTS test scores (std. β = À0.17, P = 0.02). KTRs in the lowest age-specific and sex-specific quartile of haemoglobin levels had an increased risk of being in the worst age-specific and sex-specific quartile of CER (fully adjusted OR, 2.09; 95% CI 1.15-3.77; P = 0.02), handgrip strength (fully adjusted OR, 3.30; 95% CI 1.95-5.59; P < 0.001), and FTSTS test score (fully adjusted OR, 7.21; 95% CI 2.59-20.05; P < 0.001). Conclusions Low haemoglobin levels are strongly associated with decreased muscle mass and strength in KTRs. Future investigation will need to investigate whether maintaining higher haemoglobin levels may improve muscle mass and strength in KTRs.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 92%

Decreased haemoglobin levels are associated with lower muscle mass and strength in kidney transplant recipients

Vinke

Wouters

Stam

et al. 2022

J cachexia sarcopenia muscle

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“…Association between different GNRI cutoffs with malnutrition and mortality For nondialysis CKD patients, a study showed that a low GNRI was independently associated with progression to dialysis and may be useful in predicting the risk of adverse renal outcomes in patients with CKD stages 3-5 [51]. In addition, study has shown that GNRI is a favorable predictor of muscle function in renal transplant recipients [52]. Besides, GNRI was now considerd as a novel prognostic factor for cancer patients [53,54].…”

Section: Discussionmentioning

confidence: 99%

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

Xiong

Min

Zhang

et al. 2018

Kidney Blood Press Res

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Background/Aims: Geriatric nutritional risk index (GNRI) was developed as a “nutrition-related” risk index and was reported in different populations as associated with the risk of all-cause and cardiovascular morbidity and mortality. Therefore, GNRI can be used to classify patients according to a risk of complications in relation to conditions associated with protein-energy wasting (PEW). However, not all reports pointed to the prognostic ability of the GNRI. The purpose of this study was to assess the associations of GNRI with mortality in chronic hemodialysis patients. Methods: We electronically searched original articles published in peer-reviewed journals from their inception to September 2018 in The PubMed, Embase, and the Cochrane Library databases. The primary outcome was all-cause and cardiovascular mortality. We pooled unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) using Review Manager 5.3 software. Results: A total of 10,739 patients from 19 cohort studies published from 2010 to 2018 were included. A significant negative association was found between the GNRI and all-cause mortality in patients with chronic hemodialysis (OR, 0.90; 95% CI, 0.84-0.97, p=0.004) (per unit increase) and (OR, 2.15; 95% CI, 1.88-2.46, p＜0.00001) (low vs. high GNRI). Moreover, there was also a significant negative association between the GNRI (per unit increase) and cardiovascular events (OR, 0.98; 95% CI, 0.97-1.00, p=0.01), as well as cardiovascular mortality (OR, 0.89; 95% CI, 0.80-0.99, p=0.03). Conclusion: Our findings supported the hypothesis that the low GNRI is associated with an increased risk of all-cause and cardiovascular mortality in chronic hemodialysis patients. Based on our literature review, GNRI has been found to be an effective tool for identifying patients with nutrition-related risk of all-cause and cardiovascular disease.

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“…A study in patients with NDD-CKD found that a lower GNRI was independently associated with progression to ESRD and that this parameter might be useful for predicting the poor renal outcomes in patients with stage 3-5 CKD [47]. Another study showed that the GNRI was a good predictor of muscle function in renal transplant recipients [48]. Furthermore, the GNRI is currently considered as a prognostic factor in patients with cancer [49].…”

Section: Synergistic Impact Of Gnri and Left Ventricular Hypertrophy On Patients With Ndd-ckdmentioning

confidence: 99%

Utility of Geriatric Nutritional Risk Index in Patients with Chronic Kidney Disease: A Mini-Review

2021

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Chronic kidney disease (CKD) is one of the most significant risk factors for cardiovasculardisese. Malnutrition has been recognized as a significant risk factor for cardiovascular disease in patients with CKD, including those on chronic dialysis. Current studies showed higher all-cause and cardiovascular mortality rates in patients with CKD and malnutrition. Geriatric nutritional risk index (GNRI), a simple and validated nutritional screening measure for both elderly people and patients on dialysis, is based only on three objective parameters: body weight, height, and serum albumin level. Recently, we demonstrated that the cutoff GNRI for predicting all-cause and cardiovascular mortality was 96 in patients on hemodialysis. Moreover, together with left ventricular hypertrophy and low estimated glomerular filtration rate, the utility of GNRI as a significant determinant of cardiovascular events was demonstrated in non-dialysis-dependent patients with CKD. In the present review, we summarize available evidence regarding the relationship of GNRI with all-cause and cardiovascular mortality in patients with CKD including those on dialysis.

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Geriatric Nutritional Risk Index, a Simplified Nutritional Screening Index, Is a Strong Predictor of Handgrip Strength in Renal Transplant Recipients

Cited by 9 publications

References 30 publications

Decreased haemoglobin levels are associated with lower muscle mass and strength in kidney transplant recipients

Decreased haemoglobin levels are associated with lower muscle mass and strength in kidney transplant recipients

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

Utility of Geriatric Nutritional Risk Index in Patients with Chronic Kidney Disease: A Mini-Review

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