Synergistic Effects of the Geriatric Nutritional Risk Index and the Modified Creatinine Index for Predicting Mortality in Patients on Hemodialysis

Abstract

This study aimed to investigate whether a combined estimation of the geriatric nutritional risk index (GNRI) and the modified creatinine index (mCI) provides synergistic information for mortality in patients treated by chronic hemodialysis. We analyzed 499 patients on hemodialysis for five years. We set each cut-off value as the high (≥92) and low (<92) GNRI groups and the high (≥21 mg/kg/day) and low (<21 mg/kg/day) mCI groups, and divided them into four subgroups: G1, high GNRI + high mCI; G2, high GNRI + low mCI; G3, low GNRI + high mCI; and G4, low GNRI + low mCI. The survival rate was evaluated and time-to-event analysis was performed. All-cause death occurred in 142 (28%) patients. Kaplan–Meier curves showed that G2 and G4 had a significantly worse outcome (p < 0.05) than G1 but not G3. Using the multivariable-adjusted model, only G4 was significantly associated with all-cause mortality compared with G1. Our study suggests that the synergistic effects of the GNRI and the mCI are helpful in predicting all-cause mortality. The combination of these indices may be superior to a single method to distinguish patients who are well or moderately ill from potentially severely ill.

Endocan as a Potential Marker for Predicting All-Cause Mortality in Hemodialysis Patients

“…The association between creatinine, nutrient status, and its correlation with mortality has also been studied in previous research. The utilization of the modified creatinine index, in conjunction with the Geriatric Nutritional Risk Index (GNRI) for nutrient status assessment, has shown a strong correlation with mortality in hemodialysis patients [21][22][23][24][25][26]. As an indicator of poor nutrient status and reduced muscle mass, our study also demonstrates a greater risk of all-cause mortality in hemodialysis patients with lower creatinine levels before hemodialysis.…”

Combined evaluation of Geriatric nutritional risk index and Neutrophil to lymphocyte ratio for predicting all-cause and cardiovascular mortality in hemodialysis patients

“…Lower GNRI and Cr indices were associated with an increased risk of all-cause mortality, and GNRI was considered more suitable for predicting prognosis in hemodialysis patients because it is simpler to calculate than creatinine index [ 44 ]. In addition, MHD patients with low GNRI and low modified creatinine index had significantly higher all-cause mortality and cardiovascular event mortality [ 55 ]. Consequently, we suggest that when MHD patients are in a low GNRI and high NLR state, the body’s immunity weakens, and infections and cardiovascular events increase, leading to poor prognosis.…”

Impact of the geriatric nutritional risk index on long-term outcomes in patients undergoing hemodialysis: a meta-analysis of observational studies

“…All of these were assessed for eligibility, and various reports were excluded for reasons such as review articles or irrelevant to the study population. Ultimately, 30 studies were deemed suitable and included in the meta-analysis (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53).…”

“…Additional evidence is warranted to elucidate the association between the GNRI and long-term mortality risk in hemodialysis patients through time-to-event analyses. Recently, there has been a growing trend in the number of studies conducted to examine the association between the GNRI and long-term mortality risk in patients on maintenance hemodialysis, providing an opportunity to update the existing pool of knowledge (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). This meta-analysis aimed to synthesize the current evidence and provide a quantitative estimate of the association between GNRI and mortality risk in hemodialysis patients.…”