Geriatric Nutritional Risk Index Is a Simple Predictor of Mortality in Chronic Hemodialysis Patients

Abstract

Background: Malnutrition is common in hemodialysis (HD) patients, and it is associated with increasing risk of mortality. The geriatric nutritional risk index (GNRI) has been developed as a tool to assess the nutritional risk. The aim of this study was to examine the reliability of the GNRI as a mortality predictor in a Japanese HD cohort. Methods: We prospectively examined the GNRI of 332 maintenance HD patients aged 65.4 ± 13.2, 213 males, and followed up on them for 36 months. The patients were divided into quartiles (Q) according to GNRI values (Q1: <91.6, Q2: 91.7-97.0, Q3: 97.1-102.2, Q4: >102.3). Predictors for all-cause mortality were examined using Kaplan-Meier and Cox proportional-hazards analyses. Results: The GNRI presented a normal distribution. During the follow-up period of 36 months, 76 patients died. The overall mortality at the end of the 3-year observational period was 22.3%. At the 3-year follow-up period, Kaplan-Meier survival rates for all-cause mortality were 72.3, 79.3, 84.9 and 92.6% in Q1, Q2, Q3, and Q4, respectively (p = 0.0067). Multivariate Cox proportional-hazards analysis demonstrated that the GNRI was a significant predictor of adjusted all-cause mortality (HR 0.958; 95% CI 0.929-0.989, p = 0.0073). Conclusions: The results of the present study demonstrate that the GNRI is a strong predictor of overall mortality in HD patients. However, cardiovascular mortality was not associated with GNRI values, and did not differ among the GNRI quartiles. The GNRI score can be considered a simple and reliable marker of predictor for mortality risk in Japanese HD patients.

The Diet and Haemodialysis Dyad: Three Eras, Four Open Questions and Four Paradoxes. A Narrative Review, Towards a Personalized, Patient-Centered Approach

“…The ageing of the dialysis population and the possibility of attaining long-term survival through dialysis and transplantation, has focused attention on the central role of malnutrition both in the incident population (elderly, high comorbidity), and as a characteristic of patients with a long treatment vintage [53,55,56,57,59,60,61,62,63]. Among the biomarkers associated with survival (Kt/V, Ca-P-PTH, acidosis, etc.…”

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

“…The GNRI has also successfully predicted mortality in both elderly people and chronic HD patients [12]. In other studies, however, GNRI has not been found to be a reliable predictor of all-cause and cardiovascular mortality [13][14]. Because of on this uncertainty we decided to conduct a meta-analysis of cohort and case-control studies to summarize the available evidence regarding the association of the GNRI with mortality in chronic hemodialysis patients.…”

Diagnostic Accuracy of Bioelectrical Impedance Analysis Parameters for the Evaluation of Malnutrition in Patients Receiving Hemodialysis

“…Protein‐energy wasting is characterized as the depletion of body protein and fat and is 1 of the most prevalent nutrition disorders in patients with chronic kidney disease receiving hemodialysis (HD) . Moreover, this condition is associated with an increase in morbidity and mortality rates as well as reduction in physical function and quality of life …”