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 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 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 Geriatric nutritional risk index accurately predicts cardiovascular mortality in incident hemodialysis patients

2014 ◽  
Vol 64 (1) ◽  
pp. 32-36 ◽  
Author(s):  
Hiroshi Takahashi ◽  
Yasuhiko Ito ◽  
Hideki Ishii ◽  
Toru Aoyama ◽  
Daisuke Kamoi ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Risk Index ◽  
Hemodialysis Patients ◽  
Nutritional Risk ◽  
Geriatric Nutritional Risk Index ◽  
Nutritional Risk Index

scholarly journals Utility of Geriatric Nutritional Risk Index in Patients with Chronic Kidney Disease: A Mini-Review

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 3688
Author(s):  
Naoki Nakagawa ◽  
Keisuke Maruyama ◽  
Naoyuki Hasebe
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cardiovascular Mortality ◽  
Risk Index ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Left Ventricular ◽  
Nutritional Risk ◽  
Geriatric Nutritional Risk Index ◽  
Nutritional Risk Index

Chronic kidney disease (CKD) is one of the most significant risk factors for cardiovasculardisese. Malnutrition has been recognized as a significant risk factor for cardiovascular disease in patients with CKD, including those on chronic dialysis. Current studies showed higher all-cause and cardiovascular mortality rates in patients with CKD and malnutrition. Geriatric nutritional risk index (GNRI), a simple and validated nutritional screening measure for both elderly people and patients on dialysis, is based only on three objective parameters: body weight, height, and serum albumin level. Recently, we demonstrated that the cutoff GNRI for predicting all-cause and cardiovascular mortality was 96 in patients on hemodialysis. Moreover, together with left ventricular hypertrophy and low estimated glomerular filtration rate, the utility of GNRI as a significant determinant of cardiovascular events was demonstrated in non-dialysis-dependent patients with CKD. In the present review, we summarize available evidence regarding the relationship of GNRI with all-cause and cardiovascular mortality in patients with CKD including those on dialysis.

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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