scholarly journals Lower Geriatric Nutritional Risk Index (GNRI) Is Associated with Higher Risk of Fractures in Patients Undergoing Hemodialysis

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2847
Author(s):  
Maria Yoshida ◽  
Ayumu Nakashima ◽  
Shigehiro Doi ◽  
Kazuya Maeda ◽  
Naoki Ishiuchi ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Bone Fractures ◽  
Risk Index ◽  
Serum Levels ◽  
Cox Proportional Hazards ◽  
Nutritional Risk ◽  
Geriatric Nutritional Risk Index ◽  
Kaplan Meier ◽  
Cox Proportional Hazards Models ◽  
Nutritional Risk Index

Background: Although malnutrition and bone fracture are both major complications in patients undergoing hemodialysis, their association has not been clarified. The aim of our study was to clarify the association between the geriatric nutritional risk index (GNRI), an indicator of nutritional status, and the incidence of bone fractures in patients undergoing hemodialysis. Methods: We included 1342 registered patients undergoing hemodialysis and performed a post hoc analysis. We divided patients into the high GNRI group (≥92), considered to have a low risk of malnutrition, and the low GNRI group (<92), considered to have a high risk of malnutrition. Fracture-free survival in the low and high GNRI groups was evaluated by the Kaplan–Meier method. Cox proportional hazards models were used to identify the risk factors for fractures requiring hospitalization. All results were stratified by sex. Results: New bone fractures developed in 108 (8.0%) patients in 5 years of follow-up. Bone fractures occurred more frequently in the low GNRI group compared with the high GNRI group (HR: 3.51, 95% CI: 1.91–6.42, p < 0.01 in males; HR: 2.47, 95% CI: 1.52–4.03, p < 0.01 in females). A low GNRI was significantly associated with an increased incidence of bone fractures, even after adjustment for covariates. However, the serum levels of calcium, phosphate, parathyroid hormone, and alkaline phosphatase were not associated with the incidence of bone fractures. Conclusions: A low GNRI is an independent risk factor for bone fractures in patients undergoing hemodialysis. Early intervention for the low GNRI group may be important in preventing the occurrence of fractures.

Geriatric Nutritional Risk Index Is a Simple Predictor of Mortality in Chronic Hemodialysis Patients

2015 ◽  
Vol 39 (4) ◽  
pp. 281-287 ◽  
Author(s):  
Mizuki Komatsu ◽  
Masayuki Okazaki ◽  
Ken Tsuchiya ◽  
Hiroshi Kawaguchi ◽  
Kosaku Nitta
Keyword(s):  
Proportional Hazards ◽  
Risk Index ◽  
Cox Proportional Hazards ◽  
Nutritional Risk ◽  
Geriatric Nutritional Risk Index ◽  
Kaplan Meier ◽  
Nutritional Risk Index ◽  
All Cause Mortality ◽  
Overall Mortality

Background: Malnutrition is common in hemodialysis (HD) patients, and it is associated with increasing risk of mortality. The geriatric nutritional risk index (GNRI) has been developed as a tool to assess the nutritional risk. The aim of this study was to examine the reliability of the GNRI as a mortality predictor in a Japanese HD cohort. Methods: We prospectively examined the GNRI of 332 maintenance HD patients aged 65.4 ± 13.2, 213 males, and followed up on them for 36 months. The patients were divided into quartiles (Q) according to GNRI values (Q1: <91.6, Q2: 91.7-97.0, Q3: 97.1-102.2, Q4: >102.3). Predictors for all-cause mortality were examined using Kaplan-Meier and Cox proportional-hazards analyses. Results: The GNRI presented a normal distribution. During the follow-up period of 36 months, 76 patients died. The overall mortality at the end of the 3-year observational period was 22.3%. At the 3-year follow-up period, Kaplan-Meier survival rates for all-cause mortality were 72.3, 79.3, 84.9 and 92.6% in Q1, Q2, Q3, and Q4, respectively (p = 0.0067). Multivariate Cox proportional-hazards analysis demonstrated that the GNRI was a significant predictor of adjusted all-cause mortality (HR 0.958; 95% CI 0.929-0.989, p = 0.0073). Conclusions: The results of the present study demonstrate that the GNRI is a strong predictor of overall mortality in HD patients. However, cardiovascular mortality was not associated with GNRI values, and did not differ among the GNRI quartiles. The GNRI score can be considered a simple and reliable marker of predictor for mortality risk in Japanese HD patients.

scholarly journals Methotrexate Reduces the Probability of Discontinuation of TNF Inhibitors in Seropositive Patients With Rheumatoid Arthritis. A Real-World Data Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Borja Hernández-Breijo ◽  
Claudia M. Brenis ◽  
Chamaida Plasencia-Rodríguez ◽  
Ana Martínez-Feito ◽  
Marta Novella-Navarro ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Real World ◽  
Proportional Hazards ◽  
Serum Levels ◽  
Cox Proportional Hazards ◽  
Real World Data ◽  
World Data ◽  
Kaplan Meier ◽  
Cox Proportional Hazards Models ◽  
Necrosis Factor

Tumor necrosis factor inhibitors (TNFi) are widely used for the treatment of patients with rheumatoid arthritis (RA), however a considerable percentage of patients discontinued the therapy. The aim of this study is to explore real-world TNFi survival, stratified for seropositivity, and to determine the factors that may influence it. This is a retrospective, observational and longitudinal study, using real-world data of patients, who started their first TNFi therapy between 1999 and 2018 from the RA-PAZ cohort. Patients were considered seropositive if they showed positive serum levels of either RF, ACPA, or both. Treatment survival was analyzed using Kaplan-Meier curves, and Cox proportional hazards models were used to compare the risks of TNFi discontinuation for seronegative and seropositive patients. Of the included 250 patients, 213 (85%) were seropositive. Results showed that TNFi survival did not depend on seropositivity status. However, median survival time was significant longer for seropositive patients who received concomitant MTX compared to patients who did not receive it (median [95% CI]: 3.3 yr. [2.3–4.2] vs. 2.6 yr. [1.7–3.6], respectively; p = 0.008). Furthermore, seropositive patients who received concomitant MTX were 49% less likely to discontinue TNFi therapy than patients who did not receive it (HR: 0.51; 95% CI: 0.35–0.74). In addition, we found that in seropositive patients, the use of prednisone throughout the TNFi treatment was associated with a higher likelihood of therapy discontinuation (OR: 2.30; 95% CI: 1.01–5.23). In conclusion, these data provide evidence to support the use of concomitant MTX in seropositive patients to prolong the effectiveness and the survival of the TNFi therapy. Moreover, the co-administration of prednisone in seropositive patients receiving TNFi was highly associated with TNFi discontinuation.

Geriatric nutritional risk index (GNRI) predicts long-term survival and limb events in patients with peripheral artery disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Horiguchi ◽  
H Yamagishi ◽  
K Unno ◽  
T Takamura ◽  
K Tone ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Risk Index ◽  
Nutritional Risk ◽  
Geriatric Nutritional Risk Index ◽  
Peripheral Artery ◽  
Free Survival ◽  
Kaplan Meier ◽  
Nutritional Risk Index ◽  
Artery Disease

Abstract Background Geriatric nutritional risk index (GNRI) was developed as a “nutrition-related” risk index and was reported in different populations as associated with the risk of all-cause and cardiovascular morbidity and mortality. Purpose The purpose of this study was to assess the associations of GNRI with mortality and amputation free survival in patients with peripheral artery disease (PAD). Methods From January 2011 to June 2016, 295 consecutive patients (73.3±9.2 years; 75.6% male) with PAD undergoing endovascular treatment (EVT) in our hospital were retrospectively examined. The GNRI on admission was calculated as follows: 14.89 × serum albumin (g/dl) + 41.7 × body mass index (BMI)/22. Characteristics and mortality were compared between 2 groups: low GNRI (&lt;92, n=110) with moderate or severe nutritional risk; and high GNRI (≥92, n=185) with no or low nutritional risk. Results The median follow up period was 39.4±26.4months. There were 85 deaths (28.8%) and 13 major amputation (4.4%) during the follow-up. Patients in the low-GNRI group were more often higher age, non-ambulatory state, hemodialysis and critical limb ischemia. BMI, serum hemoglobin, albumin, low-density lipoprotein were significantly lower, whereas serum C-reactive protein was significantly higher in the low-GNRI group than the high-GNRI group (P&lt;0.05, respectively). Kaplan–Meier analysis revealed that patients in the low-GNRI group had a significantly lower amputation free survival, compared to those in the high-GNRI group (log-rank test, P&lt;0.001). Conclusion The low GNRI is associated with an increased risk of mortality and limb events in patients with PAD. Amputation-free survival (Kaplan-Meier) Funding Acknowledgement Type of funding source: None

scholarly journals The Preoperative Geriatric Nutritional Risk Index (GNRI) is an Independent Prognostic Factor in Patients Underwent Curative Resection for Colorectal Cancer.

2021 ◽  
Author(s):  
Tamuro Hayama ◽  
Yojiro Hashiguchi ◽  
Tsuyoshi Ozawa ◽  
Makoto Watanabe ◽  
Yoshihisa Fukushima ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Patients ◽  
Risk Index ◽  
Nutritional Risk ◽  
Geriatric Nutritional Risk Index ◽  
Curative Surgery ◽  
Kaplan Meier ◽  
Nutritional Risk Index ◽  
Multivariable Analyses ◽  
Colorectal Cancer Patients

Abstract Purpose: T The world is becoming longer-lived, and the number of elderly colorectal cancer patients is increasing. It is very important to identify simple and inexpensive postoperative predictors in elderly colorectal cancer patients. The geriatric nutritional risk index (GNRI) is a marker of systemic nutrition and is associated with poor survival in various kinds of cancers. A few reports have investigated recurrence factors using preoperative GNRI with CRC patients. This study aimed to investigate whether preoperative GNRI is associated with recurrence-free survival (RFS) and overall survival (OS) in elderly patients with CRC.Methods: This study retrospectively enrolled 259 patients with StageⅠ-Ⅲ CRC who were more than 65 years old and underwent curative surgery at a single institution in 2012–2017. We classified them into low GNRI (RFS: ≤90.5, OS ≤101.1) group and high GNRI (RFS:>90.5, OS >101.1) group.Results: Multivariable analyses showed low GNRI group was an independent risk factor for 3-year RFS (P = 0.006) and OS (P = 0.001) in the patients with CRC. Kaplan-Meier analysis showed 3-year RFS and 3-year OS were significantly worse in the low GNRI group than in high GNRI group (p = 0.001, 0.0037).Conclusion: A low-preoperative GNRI was significantly associated with a poor prognosis in elderly CRC patients.

scholarly journals Prognostic impact of malnutrition assessed using geriatric nutritional risk index in patients aged ⩾80 years with heart failure

2019 ◽  
Vol 19 (2) ◽  
pp. 172-177 ◽  
Author(s):  
Tomohiro Nakamura ◽  
Mitsunari Matsumoto ◽  
Yumiko Haraguchi ◽  
Takeshi Ishida ◽  
Shin-ichi Momomura
Keyword(s):  
Heart Failure ◽  
Elderly Patients ◽  
Risk Index ◽  
Cox Proportional Hazards ◽  
Nutritional Risk ◽  
Prognostic Impact ◽  
Geriatric Nutritional Risk Index ◽  
Index Group ◽  
Nutritional Risk Index ◽  
The Mean

Aims: Malnutrition in elderly patients is one of the important issues in an aging society. We aimed to investigate the prevalence and prognostic impact of malnutrition assessed using the geriatric nutritional risk index in very elderly patients hospitalized owing to heart failure. Methods: We enrolled 213 consecutive patients aged ⩾80 years who were hospitalized with heart failure. The mean age was 87.2 ± 4.9 years, and 43.7% of them were male. The nutritional status on admission was evaluated using the geriatric nutritional risk index, which was calculated as follows: 14.89 × serum albumin (g/dL) + 41.7 × body mass index/22. The patients were divided into two groups, a low geriatric nutritional risk index group (<92) with malnutrition risk and a high geriatric nutritional risk index group (⩾92) without malnutrition risk. Results: The mean geriatric nutritional risk index of all patients was 90.7 ± 10.6, and 108 patients (50.7%) had low geriatric nutritional risk index. During the 540-day follow-up, the all-cause mortality was significantly higher in the low geriatric nutritional risk index group than in the high geriatric nutritional risk index group (35.7% vs. 12.9%, p < 0.001). The Cox proportional-hazards regression analysis revealed that low geriatric nutritional risk index was an independent predictor of mortality (hazard ratio, 2.28; 95% confidence interval, 1.15–4.49; p = 0.02). Conclusions: Low geriatric nutritional risk index on admission was common and was associated with poor prognosis in patients aged ⩾80 years who were hospitalized owing to heart failure.

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 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

QT Prolongation in Dialysis Patients: An Epidemiological Study with a Focus on Malnutrition

2021 ◽  
pp. 1-8
Author(s):  
Masanori Shibata ◽  
Isao Ito ◽  
Hisae Tawada ◽  
Shinkichi Taniguchi
Keyword(s):  
Risk Index ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Serum Levels ◽  
Qt Prolongation ◽  
Fat Free Mass ◽  
Nutritional Risk ◽  
Diabetic Patients ◽  
Qtc Interval ◽  
Nutritional Risk Index

<b><i>Background/Aims:</i></b> QT prolongation is a known risk factor for ventricular fibrillation and ventricular tachycardia. Therefore, more refined management is necessary to reduce sudden cardiac death secondary to such arrhythmias. <b><i>Methods:</i></b> Electrocardiographic findings were reviewed in 224 patients, and the associations of QT prolongation with various clinical parameters were examined, including the nutritional state. Correlations were also examined between QT prolongation and body composition measurements determined by multifrequency bioelectrical impedance analysis. <b><i>Results:</i></b> Prolongation of the corrected QT (QTc) interval over 0.44 s was seen in 140 patients (62.5%). QT prolongation was independent of age and dialysis therapy duration and was more frequent in diabetics (70.1%) than in nondiabetics (54.2%, <i>p</i> = 0.014) and more frequent in women (78.8%) than in men (53.5%, <i>p</i> &#x3c; 0.001). Serum levels of albumin (<i>p</i> &#x3c; 0.001) and Cr (<i>p</i> &#x3c; 0.001) and the Geriatric Nutritional Risk Index (GNRI, <i>p</i> &#x3c; 0.001) were negatively correlated with QTc interval; no significant correlation was noted with total protein, urea nitrogen, or uric acid. Negative correlations with QTc interval were found for BMI(<i>p</i> &#x3c; 0.01), percent total body water (%TBW; <i>p</i> &#x3c; 0.05), and percent intracellular water (%ICW; <i>p</i> &#x3c; 0.01) but not with the percent extracellular water/TBW ratio or edema ratio. The longer the QTc interval, the lower the fat-free mass (FFM; <i>p</i> &#x3c; 0.01) and muscle mass (MM; <i>p</i> &#x3c; 0.01), but there was no significant correlation with percent fat. <b><i>Conclusion:</i></b> These results suggest that QT prolongation is a common complication and is more frequent in women and diabetic patients. The decreases in serum albumin and Cr levels, GNRI, BMI, %TBW, %ICW, FFM, and MM together coincided with malnutrition and thus suggest a close relationship of QT prolongation with malnutrition. Management of QT prolongation may be achieved better in the future by understanding these biochemical and biophysical changes, particularly those regarding malnutrition.

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