Geriatric Nutritional Risk Index Is Associated with Unique Health Conditions and Clinical Outcomes in Chronic Kidney Disease Patients

Abstract

Malnutrition is prevalent in patients with chronic kidney disease (CKD). However, current nutrition screening tools are not specific to the CKD population. In the present study, we aimed to investigate whether the geriatric nutritional risk index (GNRI), a simple tool designed for assessing nutrition-related risks in the elderly population, is associated with unique aspects of CKD such as fluid status, residual renal function, proteinuria, and inflammation, and whether it predicts clinical outcomes. The GNRI was calculated by incorporating serum albumin and anthropometric measurements in 326 patients with nondialysis stage 3–5 CKD who were followed up from September 2011 to March 2017 for end-stage renal disease (ESRD) and the composite outcome of all-cause death and cardiovascular events. Patients were stratified into tertiles according to baseline GNRI levels. Patients in the lowest GNRI tertile were more likely to have significantly higher levels of overhydration, proteinuria, and serum inflammatory markers and tended to have lower lean body mass and estimated glomerular filtration rate when compared with patients in the middle and upper GNRI tertiles. In multivariate linear regression analyses, the GNRI was independently associated with overhydration, proteinuria, and interleukin-6. During a median follow-up of 4.9 years, 101 patients developed ESRD; 40 deaths, and 68 cardiovascular events occurred. Patients in the lowest GNRI tertile had significantly increased risks of ESRD (hazard ratio (HR): 3.15, 95% confidence interval (CI): 1.95–5.07, p < 0.001) and the composite outcome (HR: 1.79, 95% CI: 1.10–2.92, p = 0.019) in fully adjusted models (reference: middle and upper GNRI tertiles). The GNRI takes CKD-specific health conditions into account. In addition, CKD patients with lower GNRI scores had a significantly higher risk of adverse clinical outcomes. Our findings suggest that the GNRI is an appropriate tool for nutrition screening and a prognostic predictor among patients with nondialysis stage 3–5 CKD.

The relationship of the geriatric nutritional risk index to mortality and length of stay in elderly patients with acute respiratory failure: A retrospective cohort study

“…59À61 However, cutoff points of the GNRI score in elderly patients with ARF can differ from those with chronic diseases because the clinical and demographic characteristics of elderly patients with ARF are different from those with chronic diseases. 30,32,33 Most studies converted the GNRI score into categorical variable based on the distribution of the GNRI, which reduced the statistical credibility. To address this limitation, the RCS method, which has been used in various studies with large sample sizes, was adopted in our study to determine the cutoff point of the GNRI score based on the potential linear or non-linear relationship of the risk for malnutrition assessed by the GNRI score and mortality.…”

“…24 For instance, Lin et al reported cut-off values (69.7À92.4 vs 92.5À98.2 vs 98.3À110.2) in patients with chronic kidney disease and Kanemasa et al reported cut-off values (< 96.8 vs 96.8) in patients with diffuse large B cell lymphoma. 30,33 This indicates the lack of unified cutoff points for the GNRI score among all populations. In view of this, our study aimed to determine the appropriate cutoff points for the GNRI score in elderly patients with ARF.…”

Lower Geriatric Nutritional Risk Index (GNRI) Is Associated with Higher Risk of Fractures in Patients Undergoing Hemodialysis

“…Based on the abovementioned information, we consider that the low GNRI group would probably have PEW. An association between the GNRI and inflammation has been reported [ 22 , 23 ]. Overall, we suggest that a low GNRI may detect disorders linked to decreased bone strength through PEW in patients undergoing hemodialysis.…”

Early Post-Transplant Leptin Concentration Changes in Kidney Transplant Recipients

“…Based on all of the three used nutrition assessment tools (SGA, GNRI, and MIS), our patients had normal nutrition status or mild–moderate malnutrition. Only GNRI was related to leptin change largely due to the main constituents of this index, i.e., albumin and body weight, and due to the better performance in detecting sarcopenia [ 21 ]. Furthermore, elevated pre and post-transplant leptin concentration correlated with weaker handgrip strength.…”

“…GNRI does not require patient interviewing and therefore it was chosen as an additional nutrition measure. It has been shown to be an appropriate nutrition screening tool and prognostic predictor in the CKD population [ 21 ].…”