Geriatric nutritional risk index is associated with mortality in peritoneal dialysis patients

Abstract

Background: Malnutrition is one of the most common complications among dialysis patients. The Geriatric Nutritional Risk Index (GNRI) is rarely used in dialysis patients, especially peritoneal dialysis (PD).Aim: To use the GNRI to evaluate the initial nutritional state of PD patients and to examine the association between the GNRI and mortality in chronic PD patients. Methods:We retrospectively examined the medical records at our centre to identify all adults (≥18 years) who had undergone PD for over 3 months before recruitment from January 2005 to December 2017. The correlation between the GNRI and mortality was examined by Kaplan-Meier and Cox proportional hazards analyses.Results: A total of 1804 patients was enrolled in the study. Significant correlations were noted between the initial GNRI and Charlson index, uric acid, blood calcium, potassium, triglycerides, low-density lipoprotein cholesterol, haemoglobin and so on. Multivariate Cox proportional hazards analyses demonstrated that the GNRI was associated with all-cause mortality (hazard ratio = 0.96, P < 0.001, 95% confidence interval: 0.95-0.98) after adjustment. Compared with the lowest GNRI group, allcause mortality decreased significantly for each level of GNRI after adjusting for various influencing factors, and the mortality risk of the highest GNRI grade decreased by 66%. The Kaplan-Meier analysis survival rate was significantly different among the four groups in terms of all-cause mortality and cardiovascular and cerebrovascular mortality (log-rank test, P < 0.05). Conclusions:These results demonstrated that the GNRI is significantly associated with mortality and can be a simple, clinically useful marker for the assessment of nutritional status in PD patients.

Serum Zinc Concentration Correlates With Ferritin Concentration in Patients Undergoing Peritoneal Dialysis: A Cross-Sectional Study

“…Four-hour dialysate/plasma creatinine ratio is used as an indicator of peritoneal permeability ( 29 ). The Geriatric Nutritional Risk Index (GNRI) is an indicator of nutritional status calculated by (14.89 × serum albumin [g/dL]) + 41.7 × (body weight/ideal body weight [kg]) ( 30 ). Blood parameters and PD fluid parameters were measured by the Department of Clinical Laboratory, Saitama Medical Center.…”

Predictive Value of Objective Nutritional Indexes in Technique Failure in Peritoneal Dialysis Patients

“…Previous studies have reported that the CONUT score, PNI, and GNRI had significant relationship with clinical outcomes including mortality and cardiovascular disease in PD patients. [12][13][14] In this study, we detect that a high CONUT score (.3) and low PNI (#40.2) are significant independent predictor of TF (especially early TF) in PD patients even after adjustment for covariates including gender, early peritonitis, BMI, diabetes, triglyceride, HDL-C, and EF. Besides, ROC curves indicate that PNI and CONUT score have better predictive value than GNRI.…”

“…In the published literatures, the Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) score were independent predictors for allcause mortality in PD patients. [12][13][14] To our knowledge, only the CONUT score was found to be a reliable prognostic marker of TF. 14 The prognostic value of PNI and GNRI is still unclear.…”

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

“…Another study with a large Japanese cohort also demonstrated that a low/medium GNRI was related with all-cause mortality [16]. The relationship between the GNRI and mortality has been also validated in patients on PD and in those with NDD-CKD [18,19,21]. A recent meta-analysis further confirmed the findings of earlier studies reporting that a high GNRI could reduce the risk of all-cause mortality and that a lower GNRI was related with higher mortality in patients on dialysis [2].…”

“…Geriatric nutritional risk index (GNRI), which is based only on body weight, height, and serum albumin level, has been recently demonstrated as a very simple and objective tool to assess nutritional status in various pathological conditions [7,8]. Until now, several studies have examined the credibility of GNRI in assessing malnutrition and predicting all-cause mortality and cardiovascular (CV) events in patients on chronic hemodialysis [2,[8][9][10][11][12][13][14][15][16], peritoneal dialysis (PD) [17][18][19], non-dialysis-dependent (NDD) chronic kidney disease (CKD) [20,21], stroke [22][23][24][25], and heart failure [26][27][28].…”