Abstract
Malnutrition is prevalent in patients with chronic kidney disease (CKD). However, current nutrition screening tools are not specific to the CKD population. In the present study, we aimed to investigate whether the geriatric nutritional risk index (GNRI), a simple tool designed for assessing nutrition-related risks in the elderly population, is associated with unique aspects of CKD such as fluid status, residual renal function, proteinuria, and inflammation, and whether it predicts clinical outcomes. The GNRI was calculated by incorporating serum albumin and anthropometric measurements in 326 patients with nondialysis stage 3–5 CKD who were followed up from September 2011 to March 2017 for end-stage renal disease (ESRD) and the composite outcome of all-cause death and cardiovascular events. Patients were stratified into tertiles according to baseline GNRI levels. Patients in the lowest GNRI tertile were more likely to have significantly higher levels of overhydration, proteinuria, and serum inflammatory markers and tended to have lower lean body mass and estimated glomerular filtration rate when compared with patients in the middle and upper GNRI tertiles. In multivariate linear regression analyses, the GNRI was independently associated with overhydration, proteinuria, and interleukin-6. During a median follow-up of 4.9 years, 101 patients developed ESRD; 40 deaths, and 68 cardiovascular events occurred. Patients in the lowest GNRI tertile had significantly increased risks of ESRD (hazard ratio (HR): 3.15, 95% confidence interval (CI): 1.95–5.07, p < 0.001) and the composite outcome (HR: 1.79, 95% CI: 1.10–2.92, p = 0.019) in fully adjusted models (reference: middle and upper GNRI tertiles). The GNRI takes CKD-specific health conditions into account. In addition, CKD patients with lower GNRI scores had a significantly higher risk of adverse clinical outcomes. Our findings suggest that the GNRI is an appropriate tool for nutrition screening and a prognostic predictor among patients with nondialysis stage 3–5 CKD.
Highlights
The burden of chronic kidney disease (CKD) continues to increase [1]
Our findings suggest that the geriatric nutritional risk index (GNRI) is an appropriate tool for nutrition screening and a prognostic predictor among patients with nondialysis stage 3–5 CKD
We did not aim to compare the GNRI with other parameters with regard to predicting clinical outcomes, we found that a lower GNRI score predicted an elevated risk of end-stage renal disease (ESRD) and the composite outcome of death and CV events, even after adjusting for diabetes mellitus (DM), systolic blood pressure, baseline estimated glomerular filtration rate (eGFR), overhydration, urine protein-to-creatinine ratio (UPCR), and the IL-6 concentration
Summary
The burden of chronic kidney disease (CKD) continues to increase [1]. Protein energy wasting (PEW) is one of the most prevalent complications and a significant contributor to adverse outcomes in this population [2,3]. Nutritional management is of paramount importance for patients with. The essential approach to nutritional management is the early identification of CKD patients who are at risk for PEW by nutrition screening. A wide variety of screening tools are available including the Mini Nutritional Assessment (MNA) [4], Malnutrition Screening Tool (MST) [5], Malnutrition. Universal Screening Tool (MUST) [6], and Nutritional Risk Screening-2002 (NRS-2002) [7]. There is currently no specific or validated screening tool available for CKD patients
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