Association and predictive value of geriatric nutritional risk index, body composition, or bone mineral density in haemodialysis patients. Issue 4 (28th November 2020)

• Record Type: Journal Article
• Authors: Mizuiri, Sonoo; Nishizawa, Yoshiko; Doi, Toshiki; Yamashita, Kazuomi; Shigemoto, Kenichiro; Usui, Koji; Arita, Michiko; Naito, Takayuki; Doi, Shigehiro; Masaki, Takao
• Is Part Of: Nephrology. Volume 26:Issue 4(2021)
• Page Start: 341
• Page End: 349
• Publication Date: 2020-11-28
• Subjects: body composition -- bone mineral density -- geriatric nutritional risk index -- haemodialysis patients -- mortality; Nephrology -- Periodicals; Kidneys -- Diseases -- Periodicals; Nephrologists -- Periodicals; 616.61; 616.61
• DOI: 10.1111/nep.13826
• Languages: English
• ISSNs: 1320-5358

Abstract

Abstract: Aim: Assess the association and predictive value of geriatric nutritional risk index (GNRI), body composition, and bone mineral density (BMD) in haemodialysis (HD) patients. Methods: Laboratory data, body composition parameters measured via body composition monitor, and radius, lumbar spine, femoral neck BMD measured using dual energy X‐ray absorptiometry were assessed in all subjects on HD or online haemodiafiltration (HDF) at baseline. Regression analysis for GNRI, Cox proportional hazard analyses and comparison of multiple receiver operating characteristic (ROC) curves were performed. Results: Among all 264 patients, age was 65 ± 12 years and dialysis vintage was 79 (39‐144) months. GNRI tertile (T)1, T2, and T3 were 88 (85‐91), 94 (93‐95), and 98 (97‐101), respectively. Patients in GNRI T1 had lower fat tissue index (FTI), lean tissue index, and femoral neck, lumbar spine, and distal mid‐third radius BMD, but higher overhydration/extracellular fluid than patients in GNRI T2 or T3 ( P < .05). GNRI was significantly associated with FTI, lean tissue index, and femoral neck, lumbar spine, and distal mid‐third radius BMD ( P < .01). GNRI was a significant predictor of 2‐year all‐cause mortality (HR 0.92, P < .05). Area under the ROC curve for all‐cause mortality using traditional risk factors (age, sex, diabetes mellitus, cardiovascular disease, use of vasopressors for dialysis‐related hypotension, and C‐reactive protein) was 0.67 and changed by adding GNRI (0.78, P < .05), FTI (0.75), or femoral neck BMD (0.66), respectively. Conclusion: Associations between GNRI, body composition, and BMD were confirmed in HD patients. Combining GNRI with traditional risk factors improved mortality prediction in HD patients. SUMMARY AT A GLANCE: Lower geriatric nutritional risk index (GNRI) in chronic haemodialysis patients was associated with lower fat tissue index and bone mineral density, and independently predicted 2‐year all‐cause mortality. Combining GNRI with traditional risk factors (age, sex, diabetes mellitus, cardiovascular disease, use of vasopressors for dialysis‐related hypotension, and C‐reactive protein) improved mortality prediction by 16 percentage points.