Geriatric Nutritional Risk Index (GNRI) and Creatinine Index Equally Predict the Risk of Mortality in Hemodialysis Patients: J-DOPPS

Abstract

the geriatric nutritional risk index (GnRi) and creatinine (cr) index are indexes often used as nutritional surrogates in patients receiving hemodialysis. However, few studies have directly compared the clinical characteristics of these two indexes. We investigated 3,536 hemodialysis patients enrolled in the Japan DOPPS phases 4 and 5. The primary outcome was all-cause mortality and the main exposures were the GNRI and Cr index. We confirmed and compared the association between these indexes and mortality risk as estimated by a multivariable-adjusted cox proportional hazards model. During the median 2.2-year follow-up period, 414 patients died of any cause. In the multivariable-adjusted model, lower GnRi and cr index were both associated with increased risk of all-cause mortality, and these associations were further confirmed by restricted cubic spline curves. The predictability of all-cause mortality, as represented by the c-statistic, was comparable between the two indexes. furthermore, baseline nutritional surrogates that corresponded with lower GnRi or cr index values were comparable between the two indexes. Given that calculating the GnRi is simpler than calculating the cr index, our data suggest that the GnRi may be preferable to the cr index for predicting clinical outcomes in patients undergoing maintenance hemodialysis.Malnutrition is highly prevalent in patients receiving maintenance hemodialysis 1-3 . Inflammation often coexists with malnutrition. Because these two pathologies synergistically promote clinically important complications, including atherosclerotic diseases, they are now jointly recognized by the integrated term "malnutrition-inflammation-atherosclerosis (MIA) syndrome" or "malnutrition-inflammation complex/cachexia syndrome (MICS)" 4,5 . Identification of objective markers that both reflect MIA syndrome and can be used for daily evaluation of nutritional and inflammatory status in this population is now urgently required.A wide variety of nutritional and inflammatory markers and tools have been reported for the evaluation of MIA syndrome or MICS in hemodialysis patients. Because these markers and indexes are insufficient when used alone, many clinicians use them in combination in clinical practice. These include subjective global assessment (SGA); malnutrition-inflammation score (MIS); serum levels of albumin, creatinine (Cr), and C-reactive protein (CRP); body mass index (BMI); normalized protein catabolic rate (nPCR); interleukin-6; geriatric nutritional risk index (GNRI); Cr index; Objective Score of Nutrition on Dialysis (OSND); simple protein energy wasting score; Subjective Global Assessment-Dialysis Malnutrition Score (SGA-DMS); bioelectrical impedance analysis (BIA); and dual energy X-ray absorptiometry (DEXA) 3,5-15 . Of these, the GNRI and Cr index are often used to evaluate nutritional status in hemodialysis patients 9,10 . The GNRI is calculated by serum albumin level and BMI, while the Cr index is determined by age, gender, Kt/V for urea, and pre-dialysis serum Cr level. Thes...

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

“…Tsai et al 32 recently reported that SCI was an independent predictor of the presence of protein energy wasting. Moreover, Yamada et al 33 demonstrated that GNRI and SCI equally predicted all-cause mortality in hemodialysis patients. In the present study, CT-measured PMTH was independently and positively associated with both SCI and GNRI, suggesting that PMTH may be an indicator of protein energy wasting.…”

Importance of Considering Malnutrition and Sarcopenia in Order to Improve the QOL of Elderly Hemodialysis Patients in Japan in the Era of 100-Year Life

“…Furthermore, GNRI, a relevant marker for nutrition and mortality, is defined via serum albumin in addition to body weight, which is mainly determined by muscle content. We examined the importance of the creatinine index, another nutritional marker in HD patients without residual renal function, as a predictor of mortality risk [ 29 ]. The creatinine index is calculated using the following formula: Cr index = 16.21 ( +1.12 if male) − 0.06 × [age (years] − 0.08 × (single pool Kt/V) + 0.009 × [serum creatinine (μmol/L].…”

“…Thus, the creatinine index is a nutritional marker that is mainly determined in HD patients by muscle content, given the lack of apparent residual renal function. We found that lower GNRI and Cr index values were both independently and equally associated with an increased risk of all-cause mortality in a multivariable-adjusted model [ 29 ]. Taken together, these findings demonstrate that the mechanism by which malnutrition increases mortality risk in Japanese HD patients can be mostly explained by reduced muscle mass.…”

A Self-Representation-Based Fuzzy SVM Model for Predicting Vascular Calcification of Hemodialysis Patients

“…Two radiologists separately scored and averaged. The calculation of geriatric nutrition risk index (GNRI) [ 19 ] can be estimate by …”