#3355 GERIATRIC NUTRITIONAL RISK INDEX AND EARLY MORTALITY IN INCIDENT HEMODIALYSIS PATIENTS

Abstract

Abstract Background and Aims The nutrition status at initiation of hemodialysis (HD) might be associated with early mortality in patients undergoing HD. The Geriatric Nutritional Risk Index (GNRI) is a simple and useful nutritional screening method, and this study aimed to investigate the association between the initial GNRI and mortality in incident patients in the first year after initiation of HD. Method A nationwide retrospective cohort study was conducted based on the Korean Renal Data System database. Patients who underwent HD from January 2016 to December 2019 and were eligible for GNRI screening were included. They were followed up until the end of 2020 or study departure. Patients were compared by GNRI quartiles. The primary outcome was all-cause mortality, and a Cox proportional hazard model was used to analyze the association between GNRI and mortality. Accuracy comparison of the models including GNRI or body mass index (BMI) were analyzed by Receiver-operating characteristic curves, and the differences were tested by the DeLong test. Results A total of 10,545 patients were included, and the mean age was 63.9 ± 3.7 years. Patients with GNRI < 91.4 at the initiation of HD were older, were more often female, and a lower proportion of them had arteriovenous fistula for vascular access. A high GNRI value at the initiation of HD was associated with low all-cause mortality (hazard ratio (HR) 0.93; 95% confidence interval (95%CI) 0.92–0.94; p <0.001). The group with GNRI < 91.4 (Quartile 1) showed the lowest survival in the first year after HD initiation (p < 0.001). Quartile 1 and Quartile 2 (91.4 – 96.8) showed a significantly increased all-cause mortality (HR 3.64; 95%CI 2.60 – 5.10; p < 0.001 for Quartile 1 and HR 1.55; 95% CI 1.09 – 2.22; p = 0.015 for Quartile 2) in comparison with Quartile 4 (101.4 – 129.6). Risk of cardiovascular mortality was high in the Quartile 1 (vs. Quartile 4; HR 3.16; 95%CI 1.94 – 5.13; p < 0.001). In addition, Area Under the ROC Curve (AUC) values for all-cause mortality were 79.1 (95%CI 77.1–81.2) and 75.9 (95%CI 73.8–78.1) for GNRI and BMI, respectively, and the differences of AUCs were significant (p < 0.001). Conclusion This study demonstrates that low GNRI levels are associated with all-cause and cardiovascular mortality in HD patients during the early ESRD period. These findings suggest that GNRI is a significant predictor of mortality in these patients.