Geriatric nutritional risk index is a strong predictor of mortality in hemodialysis patients: data from the Riscavid cohort

Panichi, Vincenzo; Cupisti, Adamasco; Rosati, Alberto; Giorgio, Adriana Di; Scatena, Alessia; Menconi, Ophelia; Bozzoli, Laura; Bottai, Anna

doi:10.1007/s40620-013-0033-0

Cited by 76 publications

(69 citation statements)

References 22 publications

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“…Park et al [8] confirmed in Korean HD patients that GNRI may be a significant predictor of mortality. More recently, Panichi et al [16] have shown that the results of their study are closer to those of Yamada, and indicate that values lower than 92 may represent a strong indicator of unfavorable outcome in Caucasian HD patients.…”

Section: Discussionmentioning

confidence: 52%

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

et al. 2015

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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.

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Section: Discussionmentioning

confidence: 52%

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

et al. 2015

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“…Their results have been further confirmed by subsequent studies, especially from Asian chronic HD patients [8,11,21]. Besides that, studies from Italy, Netherlands and French also got similar conclusion [10,28,37]. Recently, a prospective cohort study with a total of 3436 Japanese HD participants included, Matsukuma et al demonstrated that lower GNRI levels are an independent risk factor for infection-related mortality and all-cause mortality in patients undergoing HD [32].…”

Section: Discussionmentioning

confidence: 72%

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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“…1,3 According to a recent European study, a low GNRI score can be considered a simple and reliable marker of malnutrition and a predictor for mortality risk in Caucasian HD patients. 2 According to another recent study, GNRI is a valid tool for the longitudinal assessment of nutritional status in HD patients. 11 Our previous study also showed similar findings.…”

Section: Discussionmentioning

confidence: 99%

“…1 Panichi reported that lower GNRI is associated with malnutrition and it is a strong predictor of overall mortality in HD patients and other author reported that GNRI was a simple method for predicting nutritional status and clinical outcomes in PD patients. 2,3 Onodera et al first reported the validity of the Onodera's prognostic nutritional index (OPNI) in predicting the prognosis in 189 patients undergoing gastrointestinal surgeries. 4 The equation for the OPNI includes the serum albumin level and the total lymphocyte count (TLC).…”

Section: Recently Yamada Et Al Reported That Geriatricmentioning

confidence: 99%

Relationships of Total Lymphocyte Count and Subpopulation Lymphocyte Counts with the Nutritional Status in Patients Undergoing Hemodialysis/Peritoneal Dialysis

Kim

Shin

2017

KMJ

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Objectives: Dialysis patients' nutritional indicators are quite subjective and complex and cannot be easily measured in clinical settings. Based on previous reports that total lymphocyte count (TLC) and subpopulation lymphocyte counts (SLCs) are associated with nutritional status in patients with dialysis, we designed this study to examine the relationships of the TLC and SLCs with clinical outcome and nutritional status in patients undergoing maintenance hemodialysis (HD) and peritoneal dialysis (PD). Methods: In this prospective, observational study, we enrolled 66 patients (50 HD patients and 16 PD patients) receiving stable maintenance dialysis. We evaluated the baseline parameters of height; weight; TLC; SLCs expressing CD3, CD4, CD8 and CD19; CBC; iron profile (iron, TIBC, ferritin); BUN; Cr; Na; K; total CO2; Ca; P; iPTH; protein; albumin; total cholesterol; HDL; LDL; uric acid and CRP and calculated Onodera's prognostic nutritional index (OPNI) and the Geriatric Nutritional Risk Index (GNRI) at baseline and three months. To analyze differences in the TLC and SLCs between the HD group and the PD group, we performed an independent samples t-test. Logistic regression analysis was performed to predict malnutrition in dialysis patients. In addition, to analyze changes in TLC, SLCs expressing each marker (CD3, CD4, CD8 and CD19) and other nutritional markers, we performed general linear model (GLM)-repeated measures ANOVA. Results: Mean age was 55.8 ± 12.7 years in HD paitents and 49.8 ± 14.5 years in PD patients. The duration of dialysis was 59.7 ± 52.9 months in HD patients and 66.1 ± 33.6 years in PD patients. Logistic regression analysis revealed that patients aged 60 years or older, women, and those whose CD19 SLCs were lower than 100 had a higher risk of developing malnutrition. In GLM-repeated measures ANOVA, CD19 SLCs were significantly higher in women and in patients with a shorter period of dialysis. Conclusions: Our results indicate that GNRI, OPNI, TLC and SLCs (especially CD19 count) may be significant nutritional markers in HD and PD patients.

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Geriatric nutritional risk index is a strong predictor of mortality in hemodialysis patients: data from the Riscavid cohort

Cited by 76 publications

References 22 publications

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

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

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

Relationships of Total Lymphocyte Count and Subpopulation Lymphocyte Counts with the Nutritional Status in Patients Undergoing Hemodialysis/Peritoneal Dialysis

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