The Association of Ankle Brachial Index, Protein-Energy Wasting, and Inflammation Status with Cardiovascular Mortality in Patients on Chronic Hemodialysis

Abstract

Protein-energy wasting (PEW) is highly prevalent in hemodialysis (HD) patients. We investigated the association of abnormal ankle brachial index (ABI), PEW, and chronic inflammation status with clinical prognosis in HD patients. A total of 973 HD patients were enrolled and were followed-up for 8 years. As a marker of the PEW, geriatric nutritional risk index (GNRI) was used. Cut-off levels were 91.2 for GNRI defined from previous studies and 1.9 mg/L for C-reactive protein (CRP) as median value, respectively. Abnormal ABI was seen in 332 (34.1%) patients. Declined GNRI and elevated CRP levels were independently associated with abnormal ABI (odds ratio (OR) 0.97, 95% confidence interval (CI) 0.96–0.99, p = 0.0009 and OR 1.40, 95% CI 1.07–1.83, p = 0.013, respectively). GNRI levels were also independently correlated with CRP levels (β = −0.126, p < 0.0001). During follow-up period, 283 (29.1%) patients died, including 123 (12.6%) due to cardiovascular disease (CVD). Abnormal ABI (adjusted hazard ratio (HR) 1.62, 95% CI 1.13–2.32, p = 0.0096), GNRI < 91.2 (adjusted HR 1.57, 95% CI 1.06–2.33, p = 0.023) and CRP > 1.9 mg/L (adjusted HR 1.89, 95% CI 1.31–2.77, p = 0.0007) independently predicted mortality due to CVD, respectively. In conclusion, abnormal ABI, GNRI, and CRP levels were closely associated with each other, and the combination of these variables increase their predictive values for the risk of mortality due to CVD and all-cause mortality in HD patients.

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

“…Moreover, the author further analyzed the cutoff value of CRP and nutrition status index and showed that both GNRI under 91.2 and CRP over 1.9 mg/L independently predicted mortality due to CVD, respectively. Furthermore, the combination of these variables increases their predictive values for the risk of mortality due to CVD and allcause mortality in HD patients [31]. Lee et al revealed that a worsening or stationary GNRI was independently associated with higher risk for major adverse cardiac and cerebrovascular events (MACCEs) in PD patients by multivariate cox analysis [48].…”

Geriatric Nutritional Risk Index for independent walking function in maintenance hemodialysis patients: A single‐facility retrospective cohort study

“…[1][2][3] The Geriatric Nutritional Risk Index (GNRI) was proposed by Bouillanne et al to evaluate nutritional disorders in older adults. [5][6][7][8][9][10] Sarcopenia is defined as an age-related involuntary loss of skeletal muscle mass and strength, and it results in physical disability, a poor quality of life and increased risk of death. [5][6][7][8][9][10] Sarcopenia is defined as an age-related involuntary loss of skeletal muscle mass and strength, and it results in physical disability, a poor quality of life and increased risk of death.…”

“…4 In recent years, the GNRI has been used to evaluate the nutritional condition of older adults, and an association between the GNRI and prognosis has been reported. [5][6][7][8][9][10] Sarcopenia is defined as an age-related involuntary loss of skeletal muscle mass and strength, and it results in physical disability, a poor quality of life and increased risk of death. 11,12 However, few studies have focused on the relationship between the GNRI and sarcopenia.…”

An overview of percutaneous coronary intervention in dialysis patients: Insights from a Japanese nationwide registry

“…Furthermore, transfemoral intervention, which is a known predictor of bleeding complications after PCI, was performed more frequently in dialysis patients than in nondialysis patients mainly because of the presence of an arteriovenous shunt in the upper extremity. In addition to conventional risk factors for CAD, several CKD‐related factors such as chronic inflammation, renal anemia, oxidative stress, and protein‐energy wasting may also be associated with advanced atherosclerosis and poor outcomes after PCI in dialysis patients …”

“…In addition to conventional risk factors for CAD, several CKDrelated factors such as chronic inflammation, renal anemia, oxidative stress, and protein-energy wasting may also be associated with advanced atherosclerosis and poor outcomes after PCI in dialysis patients. 1,8,15,26,27 Importantly, despite the increased risk for adverse outcomes, dialysis patients are less likely to receive guideline-recommended medical therapy and invasive procedures including PCI and CABG compared with nondialysis patients. 11,15 Physicians should recognize that the prevalence of severe CAD in dialysis patients is high, and treat these patients appropriately with both noninvasive and invasive methods including optimal medical therapy, diet therapy, cardiac rehabilitation, counseling for lifestyle improvements, PCI and CABG.…”