scholarly journals Combined Predictive Value of Extracellular Fluid/Intracellular Fluid Ratio and the Geriatric Nutritional Risk Index for Mortality in Patients Undergoing Hemodialysis

Nutrients ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 2659 ◽  
Author(s):  
Takahiro Yajima ◽  
Kumiko Yajima ◽  
Hiroshi Takahashi ◽  
Keigo Yasuda
Keyword(s):  
Risk Model ◽  
Risk Index ◽  
Survival Rates ◽  
Extracellular Fluid ◽  
Nutritional Risk ◽  
Geriatric Nutritional Risk Index ◽  
Protein Energy Wasting ◽  
Intracellular Fluid ◽  
Net Reclassification Improvement ◽  
Nutritional Risk Index

The ratio of extracellular fluid (ECF) to intracellular fluid (ICF) may be associated with mortality in patients undergoing hemodialysis, possibly associated with protein-energy wasting. We therefore investigated the relationship of the ECF/ICF ratio and the geriatric nutritional risk index (GNRI) with the all-cause and cardiovascular-specific mortality in 234 patients undergoing hemodialysis. Bioimpedance analysis of the ECF and ICF was performed and the ECF/ICF ratio was independently associated with GNRI (β = −0.247, p < 0.0001). During a median follow-up of 2.8 years, 72 patients died, of which 29 were cardiovascular. All-cause mortality was independently associated with a lower GNRI (adjusted hazard ratio [aHR] 3.48, 95% confidence interval [CI] 2.01–6.25) and a higher ECF/ICF ratio (aHR 11.38, 95%CI 5.29–27.89). Next, we divided patients into four groups: group 1 (G1), higher GNRI and lower ECF/ICF ratio; G2, lower GNRI and lower ECF/ICF ratio; G3, higher GNRI and higher ECF/ICF ratio; and G4, lower GNRI and higher ECF/ICF ratio. Analysis of these groups revealed 10-year survival rates of 91.2%, 67.2%, 0%, and 0% in G1, G2, G3, and G4, respectively. The aHR for G4 versus G1 was 43.4 (95%CI 12.2–279.8). Adding the GNRI alone, the ECF/ICF ratio alone, or both to the established risk model improved the net reclassification improvement by 0.444, 0.793 and 0.920, respectively. Similar results were obtained for cardiovascular mortality. In conclusion, the ECF/ICF ratio was independently associated with GNRI and could predict mortality in patients undergoing hemodialysis. Combining the GNRI and ECF/ICF ratio could improve mortality predictions.

scholarly journals Association of the erythropoiesis-stimulating agent resistance index and the geriatric nutritional risk index with cardiovascular mortality in maintenance hemodialysis patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245625
Author(s):  
Takahiro Yajima ◽  
Kumiko Yajima ◽  
Hiroshi Takahashi
Keyword(s):  
Cardiovascular Mortality ◽  
Risk Model ◽  
Risk Index ◽  
Resistance Index ◽  
Nutritional Risk ◽  
Maintenance Hemodialysis ◽  
Geriatric Nutritional Risk Index ◽  
Protein Energy Wasting ◽  
Net Reclassification Improvement ◽  
Nutritional Risk Index

Objective Hyporesponsiveness to erythropoiesis-stimulating agent (ESA) may be associated with protein-energy wasting. We investigated the relationship of the ESA resistance index (ERI) and the geriatric nutritional risk index (GNRI) for cardiovascular mortality in hemodialysis (HD) patients. Methods A total of 180 maintenance HD patients were enrolled. The patients were stratified by the GNRI of 91.2, a previously reported cut-off value, and the ERI of 13.7 (IU/week/kg/g/dL), a cut-off value for predicting cardiovascular-specific mortality, and they were classified into four groups (group 1[G1]: higher GNRI and lower ERI, G2: higher GNRI and higher ERI, G3: lower GNRI and lower ERI, G4: lower GNRI and higher ERI). Results The ERI was independently associated with the GNRI (β = −0.271, p = 0.0005). During a median follow-up of 4.6 years, higher ERI and lower GNRI were independently associated with cardiovascular mortality, respectively (adjusted hazard ratio [aHR], 3.10; 95% confidence interval [CI], 1.31–7.34, and aHR, 6.64; 95%CI, 2.60–16.93, respectively). The 7-year survival rates were 96.1%, 70.3%, 77.3%, and 50.1% in G1, G2, G3, and G4, respectively. The aHR values for G4 versus G1 were 12.63 (95%CI, 3.58–44.59). With regards to model discrimination, adding the GNRI alone, the ERI alone, and both to the traditional risk model significantly improved the net reclassification improvement by 0.421, 0.662, and 0.671, respectively. Similar results were obtained for all-cause mortality. Conclusion The ERI was independently associated with the GNRI, and could predict cardiovascular mortality in HD patients. Moreover, the combination of GNRI and ERI could improve the predictability for cardiovascular mortality.

scholarly journals Impact of Annual Change in Geriatric Nutritional Risk Index on Mortality in Patients Undergoing Hemodialysis

Nutrients ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3333
Author(s):  
Takahiro Yajima ◽  
Kumiko Yajima ◽  
Hiroshi Takahashi
Keyword(s):  
Cardiovascular Mortality ◽  
Risk Model ◽  
Risk Index ◽  
Nutritional Risk ◽  
Baseline Risk ◽  
First Year ◽  
Annual Change ◽  
Geriatric Nutritional Risk Index ◽  
Net Reclassification Improvement ◽  
Nutritional Risk Index

Regular nutritional assessment may decrease the mortality rate in patients undergoing hemodialysis. This study aimed to evaluate whether annual change in geriatric nutritional risk index (ΔGNRI) can precisely predict mortality. We retrospectively examined 229 patients undergoing hemodialysis who measured geriatric nutritional risk index (GNRI). Patients were divided into four groups according to the baseline GNRI of 91.2, previously reported cutoff value, and declined or maintained GNRI during the first year (ΔGNRI < 0% vs. ΔGNRI ≥ 0%): Group 1 (G1), GNRI ≥ 91.2 and ΔGNRI ≥ 0%; G2, GNRI ≥ 91.2 and ΔGNRI < 0%; G3, GNRI < 91.2 and ΔGNRI ≥ 0%; and G4, GNRI < 91.2 and ΔGNRI < 0%. They were followed for mortality. During a median follow-up of 3.7 (1.9–6.9) years, 74 patients died, of which 35 had cardiovascular-specific causes. The GNRI significantly decreased from 94.8 ± 6.3 to 94.1 ± 6.7 in the first year (p = 0.035). ΔGNRI was negatively associated with baseline GNRI (ρ = −0.199, p = 0.0051). The baseline GNRI < 91.2 and ΔGNRI < 0% were independently associated with all-cause mortality (adjusted hazard ratio (aHR) 2.59, 95%, confidence interval (CI) 1.54–4.33, and aHR 2.33, 95% CI 1.32–4.32, respectively). The 10-year survival rates were 69.8%, 43.2%, 39.9%, and 19.2% in G1, G2, G3, and G4, respectively (p < 0.0001). The aHR value for G4 vs. G1 was 3.88 (95% CI 1.62–9.48). With regards to model discrimination, adding ΔGNRI to the baseline risk model including the baseline GNRI significantly improved the net reclassification improvement by 0.525 (p = 0.0005). With similar results obtained for cardiovascular mortality. We concluded that the ΔGNRI could not only predict all-cause and cardiovascular mortality but also improve predictability for mortality; therefore, GNRI might be proposed to be serially evaluated.

scholarly journals Association of protein-energy wasting and inflammation status with mortality after coronary revascularisation in patients on haemodialysis

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001276
Author(s):  
Yoshitaka Kumada ◽  
Hideki Ishii ◽  
Satoru Oshima ◽  
Ryuta Ito ◽  
Norio Umemoto ◽  
...  
Keyword(s):  
Risk Index ◽  
Survival Rates ◽  
Coronary Revascularisation ◽  
Nutritional Risk ◽  
Protein Energy Wasting ◽  
Protein Energy ◽  
Kaplan Meier ◽  
Prediction Of Mortality ◽  
Risk Of Mortality ◽  
Nutritional Risk Index

ObjectiveProtein-energy wasting is associated with chronic inflammation and advanced atherosclerosis in haemodialysis (HD) patients. We investigated association of geriatric nutritional risk index (GNRI), C reactive protein (CRP) with prediction of mortality after coronary revascularisation in chronic HD patients.MethodsWe enrolled 721 HD patients electively undergoing coronary revascularisation. They were divided into tertiles according to preprocedural GNRI levels (tertile 1 (T1):<91.5, T2: 91.5–98.1 and T3:>98.1) and CRP levels (T1:≤1.4 mg/L, T2: 1.5–7.0 mg/L and T3:≥7.1 mg/L).ResultsKaplan-Meier 10 years survival rates were 32.3%, 44.8% and 72.5% in T1, T2 and T3 of GNRI and 60.9%, 49.2% and 23.5% in T1, T2 and T3 of CRP, respectively (p<0.0001 in both). Declined GNRI (HR 2.40, 95% CI 1.58 to 3.74, p<0.0001 for T1 vs T3) and elevated CRP (HR 2.31, 95% CI 1.58 to 3.43, p<0.0001 for T3 vs T1) were identified as independent predictors of mortality. In combined setting of both variables, risk of mortality was 5.55 times higher (95% CI 2.64 to 13.6, p<0.0001) in T1 of GNRI with T3 of CRP than in T3 of GNRI with T1 of CRP. Addition of GNRI and CRP in a model with established risk factors improved C-statistics (0.648 to 0.724, p<0.0001) greater than that of each alone.ConclusionPreprocedural declined GNRI and elevated CRP were closely associated with mortality after coronary revascularisation in chronic HD patients. Furthermore, combination of both variables not only stratified risk of mortality but also improved the predictability.

scholarly journals Methods and Nutritional Interventions to Improve the Nutritional Status of Dialysis Patients in JAPAN—A Narrative Review

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1390
Author(s):  
Yoshihiko Kanno ◽  
Eiichiro Kanda ◽  
Akihiko Kato
Keyword(s):  
Medical Staff ◽  
Salt Intake ◽  
Risk Index ◽  
Nutritional Risk ◽  
Registered Dietitians ◽  
Dialysis Therapy ◽  
Protein Energy Wasting ◽  
Nutritional Interventions ◽  
Protein Energy ◽  
Nutritional Risk Index

Patients receiving dialysis therapy often have frailty, protein energy wasting, and sarcopenia. However, medical staff in Japan, except for registered dietitians, do not receive training in nutritional management at school or on the job. Moreover, registered dietitians work separately from patients and medical staff even inside a hospital, and there are many medical institutions that do not have registered dietitians. In such institutions, medical staff are required to manage patients’ nutritional disorders without assistance from a specialist. Recent studies have shown that salt intake should not be restricted under conditions of low nutrition in frail subjects or those undergoing dialysis, and protein consumption should be targeted at 0.9 to 1.2 g/kg/day. The Japanese Society of Dialysis Therapy suggests that the Nutritional Risk Index-Japanese Hemodialysis (NRI-JH) is a useful tool to screen for older patients with malnutrition.

scholarly journals Association between geriatric nutritional risk index and stroke risk in hemodialysis patients: 10-Years outcome of the Q-Cohort study

2021 ◽  
Vol 323 ◽  
pp. 30-36
Author(s):  
Shoji Tsuneyoshi ◽  
Yuta Matsukuma ◽  
Yasuhiro Kawai ◽  
Hiroto Hiyamuta ◽  
Shunsuke Yamada ◽  
...  
Keyword(s):  
Cohort Study ◽  
Stroke Risk ◽  
Risk Index ◽  
Hemodialysis Patients ◽  
Nutritional Risk ◽  
Geriatric Nutritional Risk Index ◽  
Nutritional Risk Index
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