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Geriatric nutritional risk index accurately predicts cardiovascular mortality in incident hemodialysis patients.
J Cardiol. 2014 Jul; 64(1):32-6.JC

Abstract

BACKGROUND

Cardiovascular disease (CVD) is a leading cause of death in end-stage renal disease (ESRD) patients. Protein-energy wasting (PEW) or malnutrition is common in this population, and is associated with increasing risk of mortality. The geriatric nutritional risk index (GNRI) has been developed as a tool to assess the nutritional risk, and is associated with mortality not only in elderly patients but also in ESRD patients. However, whether the GNRI could predict the mortality due to CVD remains unclear in this population. We investigated the prognostic value of GNRI at initiation of hemodialysis (HD) therapy for CVD mortality in a large cohort of ESRD patients.

METHODS

Serum albumin, body weight, and height for calculating GNRI were measured in 1568 ESRD patients. Thereafter, the patients were divided into quartiles according to GNRI levels [quartile 1 (Q1): < 84.9; Q2: 85.0-91.1; Q3: 91.2-97.2; and Q4: >97.3], and were followed up for up to 10 years.

RESULTS

GNRI levels independently correlated with serum C-reactive-protein levels (β = -0.126, p < 0.0001). Rates of freedom from CVD mortality for 10 years were 57.9%, 73.3%, 80.8%, and 89.2% in Q1, Q2, Q3, and Q4, respectively (p < 0.0001). The GNRI was an independent predictor of CVD mortality (hazard ratio 3.42, 95% confidence interval 2.05-5.70, p < 0.0001 for Q1 vs. Q4). C-index was also greater in an established CVD risk model with GNRI (0.749) compared to that with albumin (0.730), body mass index (0.732), and alone (0.710). Similar results were observed for all-cause mortality.

CONCLUSION

GNRI at initiation of HD therapy could predict CVD mortality with incremental value of the predictability compared to serum albumin and body mass index in ESRD patients.

Authors+Show Affiliations

Cardiovascular Center, Nagoya Kyoritsu Hospital, Nagoya, Japan; Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan.Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: yasuito@med.nagoya-u.ac.jp.Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.Cardiovascular Center, Nagoya Kyoritsu Hospital, Nagoya, Japan.Cardiovascular Center, Nagoya Kyoritsu Hospital, Nagoya, Japan.Department of Nephrology, Nagoya Kyoritsu Hospital, Nagoya, Japan.Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24365385

Citation

Takahashi, Hiroshi, et al. "Geriatric Nutritional Risk Index Accurately Predicts Cardiovascular Mortality in Incident Hemodialysis Patients." Journal of Cardiology, vol. 64, no. 1, 2014, pp. 32-6.
Takahashi H, Ito Y, Ishii H, et al. Geriatric nutritional risk index accurately predicts cardiovascular mortality in incident hemodialysis patients. J Cardiol. 2014;64(1):32-6.
Takahashi, H., Ito, Y., Ishii, H., Aoyama, T., Kamoi, D., Kasuga, H., Yasuda, K., Maruyama, S., Matsuo, S., Murohara, T., & Yuzawa, Y. (2014). Geriatric nutritional risk index accurately predicts cardiovascular mortality in incident hemodialysis patients. Journal of Cardiology, 64(1), 32-6. https://doi.org/10.1016/j.jjcc.2013.10.018
Takahashi H, et al. Geriatric Nutritional Risk Index Accurately Predicts Cardiovascular Mortality in Incident Hemodialysis Patients. J Cardiol. 2014;64(1):32-6. PubMed PMID: 24365385.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Geriatric nutritional risk index accurately predicts cardiovascular mortality in incident hemodialysis patients. AU - Takahashi,Hiroshi, AU - Ito,Yasuhiko, AU - Ishii,Hideki, AU - Aoyama,Toru, AU - Kamoi,Daisuke, AU - Kasuga,Hirotake, AU - Yasuda,Kaoru, AU - Maruyama,Shoichi, AU - Matsuo,Seiichi, AU - Murohara,Toyoaki, AU - Yuzawa,Yukio, Y1 - 2013/12/22/ PY - 2013/08/24/received PY - 2013/10/21/revised PY - 2013/10/29/accepted PY - 2013/12/25/entrez PY - 2013/12/25/pubmed PY - 2015/4/7/medline KW - Albumin KW - BMI KW - Cardiovascular mortality KW - GNRI KW - Hemodialysis SP - 32 EP - 6 JF - Journal of cardiology JO - J Cardiol VL - 64 IS - 1 N2 - BACKGROUND: Cardiovascular disease (CVD) is a leading cause of death in end-stage renal disease (ESRD) patients. Protein-energy wasting (PEW) or malnutrition is common in this population, and is associated with increasing risk of mortality. The geriatric nutritional risk index (GNRI) has been developed as a tool to assess the nutritional risk, and is associated with mortality not only in elderly patients but also in ESRD patients. However, whether the GNRI could predict the mortality due to CVD remains unclear in this population. We investigated the prognostic value of GNRI at initiation of hemodialysis (HD) therapy for CVD mortality in a large cohort of ESRD patients. METHODS: Serum albumin, body weight, and height for calculating GNRI were measured in 1568 ESRD patients. Thereafter, the patients were divided into quartiles according to GNRI levels [quartile 1 (Q1): < 84.9; Q2: 85.0-91.1; Q3: 91.2-97.2; and Q4: >97.3], and were followed up for up to 10 years. RESULTS: GNRI levels independently correlated with serum C-reactive-protein levels (β = -0.126, p < 0.0001). Rates of freedom from CVD mortality for 10 years were 57.9%, 73.3%, 80.8%, and 89.2% in Q1, Q2, Q3, and Q4, respectively (p < 0.0001). The GNRI was an independent predictor of CVD mortality (hazard ratio 3.42, 95% confidence interval 2.05-5.70, p < 0.0001 for Q1 vs. Q4). C-index was also greater in an established CVD risk model with GNRI (0.749) compared to that with albumin (0.730), body mass index (0.732), and alone (0.710). Similar results were observed for all-cause mortality. CONCLUSION: GNRI at initiation of HD therapy could predict CVD mortality with incremental value of the predictability compared to serum albumin and body mass index in ESRD patients. SN - 1876-4738 UR - https://www.unboundmedicine.com/medline/citation/24365385/Geriatric_nutritional_risk_index_accurately_predicts_cardiovascular_mortality_in_incident_hemodialysis_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0914-5087(13)00352-3 DB - PRIME DP - Unbound Medicine ER -