Impact of Geriatric Nutritional Risk Index and Modified Creatinine Index Combination on Mortality in Hemodialysis Patients.

Hayato Fujioka,Hidenori Yamazaki,Tsutomu Koike,Fumihiro Tomoda,Kota Kakeshita,Koichiro Kinugawa,Teruhiko Imamura

doi:10.3390/nu14040801

Hayato Fujioka, Hidenori Yamazaki + Show 5 more

Open Access

https://doi.org/10.3390/nu14040801

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Journal: Nutrients	Publication Date: Feb 14, 2022
Citations: 11	License type: CC BY 4.0

Affiliation: University of Toyama

Abstract

The prognostic impact of the combination of a geriatric nutritional risk index (GRNI) and modified creatinine index, both of which assess nutritious status in hemodialysis patients, has not yet been well investigated thus far. Patients receiving maintenance hemodialysis in our institutes between February 2011 and January 2017 were retrospectively included. The baseline GRNI and modified Creatinine index were calculated and the impact of their combination on 5-year all-cause mortality following the index hemodialysis was investigated. A total of 183 patients (68.3 ± 12.4 years, 98 men, hemodialysis duration 97 ± 89 months) were followed from the index hemodialysis for 5.5 years. Mean GNRI was 91.2 and mean modified Creatinine index was 22.2 in men and 19.6 in women. The 5-year survival was significantly stratified by the median values of GNRI and modified Creatinine index (p < 0.05 for both). Patients with low GNRI and a low modified Creatinine index had lower 5-year survival than those with the other three combination patterns (p < 0.05). A combination of GNRI and modified Creatinine index may be a promising tool to risk stratify mortality in dialysis patients.

Highlights

Hemodialysis patients often have malnutrition and chronic inflammation, both of which synergistically progress end-organ dysfunction and atherosclerotic diseases [1,2].This has recently been called malnutrition-inflammation-atherosclerosis syndrome
geriatric nutritional risk index (GNRI) is a simple tool for assessing nutritional status in various pathological conditions based on body mass index and serum albumin levels, focusing on visceral protein assessment [7]
We investigated, for the first time, the impact of a combination of two major malnutrition indexes, GNRI and modified Cr index on mortality in patients receiving maintenance hemodialysis

Summary

Introduction

Hemodialysis patients often have malnutrition and chronic inflammation, both of which synergistically progress end-organ dysfunction and atherosclerotic diseases [1,2]. This has recently been called malnutrition-inflammation-atherosclerosis syndrome. The unique malnutrition status in patients with hemodialysis, focusing on reduced dietary intake, chronic inflammation, resistance to anabolic hormones, loss of amino acids via dialysate, and muscle protein breakdown by hemodialysis, is called protein-energy wasting [3]. Several indexes to assess protein-energy wasting, including geriatric nutritional risk index (GNRI) and modified creatinine (Cr) index, have been introduced [6–11]. GNRI is a simple tool for assessing nutritional status in various pathological conditions based on body mass index and serum albumin levels, focusing on visceral protein assessment [7]

Results

Discussion

Conclusion