Prognostic nutritional index is a predictor of mortality in elderly patients with chronic kidney disease

Ataş, Dilek Barutçu; Tuğcu, Murat; Aşıcıoğlu, Ebru; Velioğlu, Arzu; Arıkan, Hakkı; Koç, Mehmet

doi:10.1007/s11255-021-03002-6

Cited by 21 publications

(21 citation statements)

References 38 publications

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“…Emerging evidence have proved that PNI could predict the prognosis of several types of cancer [ 6 , 7 , 21 , 22 ], cardiovascular diseases [ 8 , 23 ] and acute kidney injury [ 24 ]. Furthermore, PNI was also related with the increased risk of mortality in children [ 25 ] and older patients with CKD [ 10 ]. In this study, we also demonstrated that PNI was significantly related with CKD and all-cause mortality in total study population.…”

Section: Discussionmentioning

confidence: 99%

“…It was first established in 1984 and used to evaluate the prognosis of cancer initially [ 7 ]. Recent studies have suggested that the PNI is also related with the prognosis of cardiovascular disease, COVID-19, and chronic kidney disease (CKD) [ 8 – 10 ]. T2DM has been proved to be a low-grade inflammation state, in which the immune disorders and malnutrition are also not uncommon [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Prognostic nutritional index as a risk factor for diabetic kidney disease and mortality in patients with type 2 diabetes mellitus

et al. 2022

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Aims Microinflammation and malnutrition are common in individuals with type 2 diabetes mellitus (T2DM). We aimed to validate whether prognostic nutritional index (PNI) may increase the risk of diabetic kidney disease (DKD) and all-cause mortality in T2DM patients. Methods This retrospective cohort study was based on the National Health and Nutrition Examination Survey (NHANES) and National Death Index (NDI) 2013–2018 database. A total of 14,349 eligible subjects were included, and 2720 of them were with T2DM. PNI was assessed by the 5 × lymphocyte count (10 9 /L) + serum albumin (g/L). The Logistic and Cox regression analyses were conducted to investigate the risk factors of DKD and mortality in T2DM patients. Results For 14,349 participants represented 224.7 million noninstitutionalized residents of the United State, the average PNI was 53.72 ± 0.12, and the prevalence of T2DM was 14.89%. T2DM patients had a lower level of PNI and dietary protein intake, a higher risk of mortality, kidney injury, anemia, arterial hypertension and hyperuricemia, compared with non-T2DM subjects. DKD occurred in 35.06% of diabetic participants and a higher PNI was independently related with a lower risk of DKD (OR 0.64, 95% CI 0.459–0.892, p = 0.01) in T2DM after multivariate adjustment. During a median follow-up of 46 person-months (29–66 months), a total of 233 T2DM individuals died from all causes (mortality rate = 8.17%). Subjects with T2DM who had a higher PNI showed a lower risk of all-cause mortality (HR 0.60, 95% CI 0.37–0.97, p = 0.036). Conclusions PNI, as a marker of immunonutrition, correlated with the incidence of DKD, and was an independent predictor for all-cause mortality in participants with T2DM. Thus, PNI may conduce to the risk stratification and timely intervention of T2DM patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prognostic nutritional index as a risk factor for diabetic kidney disease and mortality in patients with type 2 diabetes mellitus

et al. 2022

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“…One of the combinations of albumin with the TLC found in the literature is the PNI, by Onodera et al, 8 which is easy to calculate [24][25][26] using preoperative laboratory data, 25 which in turn are objective markers of low cost. 24 Initially associated with surgical risk for patients with gastrointestinal malignancy, 8 PNI is currently used as a nutritional marker predictive of mortality in patients with several diseases, such as cancer, 25,26 Non-tuberculous mycobacterial infection, 27 chronic kidney disease, 28 burn wounds 29 and cardiovascular diseases. 9,24,30 The exact mechanisms for which PNI is related to postoperative prognosis are not well comprehended, however, some of these potential mechanisms were reported.…”

Section: Discussionmentioning

confidence: 99%

“…9,24,30 The exact mechanisms for which PNI is related to postoperative prognosis are not well comprehended, however, some of these potential mechanisms were reported. Firstly, the serum albumin level is widely used to assess nutritional and inflammatory systemic aspects of patients 26,28,29 and secondly, the lymphocytes represent a major role in immune response, and their functions and values are deeply altered after sepsis and other acute lesions such as complex surgeries. 29 Regarding cardiovascular surgeries, it was observed that patients with coronary artery disease, with a mean follow-up of 7 years, had higher incidence not only of mortality by all causes, but also of cardiac mortality when presented lower preoperative PNI.…”

Section: Discussionmentioning

confidence: 99%

Prognostic nutritional index and mortality in children and adolescents underwent cardiac surgery

Silva

Batista

Pires

et al. 2022

Rev. Bras. Saude Mater. Infant.

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Objectives: to analyze the prognostic nutritional index and factors associated with mortality in children and adolescents with heart disease who underwent cardiac surgery. Methods: this is a longitudinal, retrospective study that included 98 children and adolescents with heart disease from 0 to 14 years old, and assessed the prognostic nutritional index and nutritional status, through the body mass index for age, weight for height, weight for age and height for age. Multiple logistic regression analysis was performed. Results: malnutrition was present in 27 patients, 68 were categorized as having a low prognostic nutritional index and 16 died. In the adjusted analysis, malnutrition (OR=4.11; CI95%=1.26-13.40; p=0.019), the low body mass index for age (OR=4.14; CI95%=1.26-13.61; p=0.019), low weight for height (OR=4.15; CI95%=1.29-13.35; p=0.017) and low weight for age (OR=5.20; CI95%=1.39-19.43; p=0.014) were associated with mortality. Conclusions: malnutrition, low body mass index for age, weight for height and weight for age had shown a significant association with mortality. Despite being an easily applicable indicator of nutritional status, the findings suggest no association between the prognostic nutritional index and mortality in patients with congenital heart disease after cardiac surgery.

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“…Previous studies ( 14 – 18 ) demonstrated that the PNI is related to poor clinical outcomes and predicts survival in a variety of solid tumors, postoperative complications, and other disease states. A cut-off point of the PNI score < 39 points has been recognized as an independent prognostic marker of clinical and mortality outcomes in older patients with CKD ( 19 , 20 ) and patients with dialysis ( 21 , 22 ).…”

Section: Introductionmentioning

confidence: 99%

Comorbidity and nutritional status in adult with advanced chronic kidney disease influence the decision-making choice of renal replacement therapy modality: A retrospective 5-year study

Álvarez-García

Pérez²,

Alaguero³

et al. 2023

Front. Nutr.

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BackgroundNutritional and inflammation status are significant predictors of morbidity and mortality risk in advanced chronic kidney disease (ACKD). To date, there are a limited number of clinical studies on the influence of nutritional status in ACKD stages 4–5 on the choice of renal replacement therapy (RRT) modality.AimThis study aimed to examine relationships between comorbidity and nutritional and inflammatory status and the decision-making on the choice of RRT modalities in adults with ACKD.MethodsA retrospective cross-sectional study was conducted on 211 patients with ACKD with stages 4–5 from 2016 to 2021. Comorbidity was assessed using the Charlson comorbidity index (CCI) according to severity (CCI: ≤ 3 and >3 points). Clinical and nutritional assessment was carried out by prognosis nutritional index (PNI), laboratory parameters [serum s-albumin, s-prealbumin, and C-reactive protein (s-CRP)], and anthropometric measurements. The initial decision-making of the different RRT modalities [(in-center, home-based hemodialysis (HD), and peritoneal dialysis (PD)] as well as the informed therapeutic options (conservative treatment of CKD or pre-dialysis living donor transplantation) were recorded. The sample was classified according to gender, time on follow-up in the ACKD unit (≤ 6 and >6 months), and the initial decision-making of RRT (in-center and home-RRT). Univariate and multivariate regression analyses were carried out for evaluating the independent predictors of home-based RRT.ResultsOf the 211 patients with ACKD, 47.4% (n = 100) were in stage 5 CKD, mainly elderly men (65.4%). DM was the main etiology of CKD (22.7%) together with hypertension (96.6%) as a CV risk factor. Higher CCI scores were significantly found in men, and severe comorbidity with a CCI score > 3 points was 99.1%. The mean time of follow-up time in the ACKD unit was 9.6 ± 12.8 months. A significantly higher CCI was found in those patients with a follow-up time > 6 months, as well as higher mean values of eGFR, s-albumin, s-prealbumin, s-transferrin, and hemoglobin, and lower s-CRP than those with a follow-up <6 months (all, at least p < 0.05). The mean PNI score was 38.9 ± 5.5 points, and a PNI score ≤ 39 points was found in 36.5%. S-albumin level > 3.8 g/dl was found in 71.1% (n = 150), and values of s-CRP ≤ 1 mg/dl were 82.9% (n = 175). PEW prevalence was 15.2%. The initial choice of RRT modality was higher in in-center HD (n = 119 patients; 56.4%) than in home-based RRT (n = 81; 40.5%). Patients who chose home-based RRT had significantly lower CCI scores and higher mean values of s-albumin, s-prealbumin, s-transferrin, hemoglobin, and eGFR and lower s-CRP than those who chose in-center RRT (p < 0.001). Logistic regression demonstrated that s-albumin (OR: 0.147) and a follow-up time in the ACKD unit >6 months (OR: 0.440) were significantly associated with the likelihood of decision-making to choose a home-based RRT modality (all, at least p < 0.05).ConclusionRegular monitoring and follow-up of sociodemographic factors, comorbidity, and nutritional and inflammatory status in a multidisciplinary ACKD unit significantly influenced decision-making on the choice of RRT modality and outcome in patients with non-dialysis ACKD.

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Prognostic nutritional index is a predictor of mortality in elderly patients with chronic kidney disease

Cited by 21 publications

References 38 publications

Prognostic nutritional index as a risk factor for diabetic kidney disease and mortality in patients with type 2 diabetes mellitus

Prognostic nutritional index as a risk factor for diabetic kidney disease and mortality in patients with type 2 diabetes mellitus

Prognostic nutritional index and mortality in children and adolescents underwent cardiac surgery

Comorbidity and nutritional status in adult with advanced chronic kidney disease influence the decision-making choice of renal replacement therapy modality: A retrospective 5-year study

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