Geriatric Nutritional Risk Index, a simplified nutritional screening index, is a significant predictor of mortality in chronic dialysis patients

Zadeh has reported that malnutrition-Inflammation Score (MIS) is predictor of mortality in hemodialysis patients. Although Yamada has reported that the significant correlation between Geriatric Nutritional Risk Index (GNRI) and MIS, they did not report the correlation between GNRI and mortality in chronic hemodialysis patients. This article has reported that GNRI is significant predictor of mortality in chronic dialysis patients.

Geriatric Nutritional Risk Index, a simplified nutritional screening index, is a significant predictor of mortality in chronic dialysis patients

Ikue Kobayashi, Eiji Ishimura, Yoko Kato, Senji Okuno, Tadashi Yamamoto, Tomoyuki Yamakawa, Katsuhito Mori, Masaaki Inaba and Yoshiki Nishizawa

Nephrol Dial Transplant (2010) 25: 3361-3365

Abstract

Background

Malnutrition is a common complication in haemodialysis patients. Recently, the Geriatric Nutritional Risk Index (GNRI) has been reported as a simple and accurate tool to assess nutritional status of haemodialysis patients. Our objective was to examine the association between GNRI and mortality in chronic haemodialysis patients.

Methods

We examined the GNRI of 490 maintenance haemodialysis patients (60 ± 12 years, 293 males and 197 females) and followed up these patients for 60 months. Predictors for all-cause death were examined using Kaplan–Meier analysis and Cox proportional analyses.

Results

The GNRI was 98.0 ± 6.0, and was significantly and negatively correlated with age and haemodialysis duration. During the 60-month follow-up period, 129 patients died. According to the highest positive likelihood and risk ratios, the cutoff value of GNRI for mortality was set at 90. Kaplan–Meier analysis revealed that patients with a GNRI <90 (n = 50) had a significantly lower survival rate, compared to those with GNRI ≥90 (n = 440) (log-rank test, P < 0.0001). Multivariate Cox proportional hazards analyses demonstrated that GNRI was a significant predictor for mortality [hazard ratio (HR) 0.962, 95% confidence interval (CI) 0.931–0.995, P < 0.05], after adjustment for age, gender, C-reactive protein, presence of diabetes and haemodialysis duration.

Conclusions

These results demonstrated that GNRI is a significant predictor for mortality in haemodialysis patients. The simple method of GNRI is considered to be a clinically useful marker for the assessment of nutritional status in haemodialysis patients.

Keywords: Geriatric Nutritional Risk Index; haemodialysis; malnutrition; mortality

Geriatric Nutritional Risk Indexは簡易栄養スクリーニング指標であるが,維持透析患者の死亡率の有意な指標である

 維持透析患者の MIS と死亡率との相関 Zadeh らが報告し,GNRI と MIS との相関の強さは Yamada が報告しておりますが,Yamada の報告では GNRI と透析患者の死亡率との比較はありませんでした.この論文は GNRI と透析患者の死亡率とを直接比較した報告です.

Geriatric Nutritional Risk Indexは簡易栄養スクリーニング指標であるが,維持透析患者の死亡率の有意な指標である

Ikue Kobayashi, Eiji Ishimura, Yoko Kato, Senji Okuno, Tadashi Yamamoto, Tomoyuki Yamakawa, Katsuhito Mori, Masaaki Inaba and Yoshiki Nishizawa

Nephrol Dial Transplant (2010) 25: 3361-3365

要旨

背景

 低栄養は透析患者の一般的合併症である.最近 Geriatric Nutritional Risk Index (GNRI) が透析患者の栄養状態を簡易で正確に評価するツールとして報告されるようになってきた.我々の研究では透析患者の GNRI と死亡率との相関を調査した.

方法

 我々は 490 名の維持透析患者 (60 ± 12 歳,男性 293 名,女性 197 名) の GNRI を調査し,60 ヶ月間に渡って経過を観察した.全死亡の指標を Kaplan-Meyer 法と Cox 比例ハザード法で検証した.

結果

 GNRI は98.0 ± 6.0 であり,有意に年齢および透析期間と負の相関があった.60 ヶ月間の観察期間中 129 名が死亡した.死亡を鑑別する GNRI の陽性尤度比が最大となるカットオフ値は 90 であった.Kaplan-Meyer 法によると GNRI 90 未満の患者 (n = 50) の生存率は 90 以上の患者 (n = 440) と比較して有意に低かった(log-rank検定p < 0.0001).多変量の Cox 比例ハザード解析ではGNRI が死亡率の有意な指標となることが明らかとなった(年齢,性別,CRP, 糖尿病の存在および透析期間で調整後のハザード比 0.962, 95%CI 0.931 – 0.995, p < 0.05).

結論

 これらの結果は GNRI が透析患者の死亡率の有意な指標であることを示している.この GNRI の簡易な手法は透析患者の栄養状態を評価する臨床的に有用なマーカーであると考えられる.

キーワード:Geriatric Nutritional Risk Index; haemodialysis; malnutrition; mortality

A Malnutrition-Inflammation Score Is Correlated With Morbidity and Mortality in Maintenance Hemodialysis Patients

I read the paper below, which is referenced from the paper I have read previously. This article describes that Malnutrition-Inflammation Score (MIS) is a predictor of dialysis outcome and an indicator of malnutrition inflammation complex syndrome (MICS). MIS was developed from Dialysis Malnutrition Score (DMS), which was developed from Subjective Global Assessment (SGA).

A Malnutrition-Inflammation Score is correlated with morbidity and mortality in maintenance hemodialysis patients

Kamyar Kalantar-Zadeh, MD, Joel D. Kopple, MD, Gladys Block, PhD, Michael H. Humphreys, MD

Abstract

Malnutrition inflammation complex syndrome (MICS) occurs commonly in maintenance hemodialysis (MHD) patients and may correlate with increased morbidity and mortality. An optimal, comprehensive, quantitative system that assesses MICS could be a useful measure of clinical status and may be a predictor of outcome in MHD patients. We therefore attempted to develop and validate such an instrument, comparing it with conventional measures of nutrition and inflammation, as well as prospective hospitalization and mortality. Using components of the conventional Subjective Global Assessment (SGA), a semiquantitative scale with three severity levels, the Dialysis Malnutrition Score (DMS), a fully quantitative scoring system consisting of 7 SGA components, with total score ranging between 7 (normal) and 35 (severely malnourished), was recently developed. To improve the DMS, we added three new elements to the 7 DMS components: body mass index, serum albumin level, and total iron-binding capacity to represent serum transferrin level. This new comprehensive Malnutrition-Inflammation Score (MIS) has 10 components, each with four levels of severity, from 0 (normal) to 3 (very severe). The sum of all 10 MIS components ranges from 0 to 30, denoting increasing degree of severity. These scores were compared with anthropometric measurements, near-infrared-measured body fat percentage, laboratory measures that included serum C-reactive protein (CRP), and 12-month prospective hospitalization and mortality rates. Eighty-three outpatients (44 men, 39 women; age, 59 ± 15 years) on MHD therapy for at least 3 months (43 ± 33 months) were evaluated at the beginning of this study and followed up for 1 year. The SGA, DMS, and MIS were assessed simultaneously on all patients by a trained physician. Case-mix-adjusted correlation coefficients for the MIS were significant for hospitalization days (r = 0.45; P < 0.001) and frequency of hospitalization (r = 0.46; P < 0.001). Compared with the SGA and DMS, most pertinent correlation coefficients were stronger with the MIS. The MIS, but not the SGA or DMS, correlated significantly with creatinine level, hematocrit, and CRP level. During the 12-month follow-up, 9 patients died and 6 patients left the cohort. The Cox proportional hazard-calculated relative risk for death for each 10-unit increase in the MIS was 10.43 (95% confidence interval, 2.28 to 47.64; P = 0.002). The MIS was superior to its components or different subversions for predicting mortality. The MIS appears to be a comprehensive scoring system with significant associations with prospective hospitalization and mortality, as well as measures of nutrition, inflammation, and anemia in MHD patients. The MIS may be superior to the conventional SGA and the DMS, as well as to individual laboratory values, as a predictor of dialysis outcome and an indicator of MICS.