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Interaction between geriatric nutritional risk index and decoy receptor 3 predicts mortality in chronic hemodialysis patients.
Am J Nephrol. 2014; 40(3):191-9.AJ

Abstract

BACKGROUND

Protein-energy wasting (PEW) is common and associated with poor outcome in hemodialysis patients. In hemodialysis patients, geriatric nutritional risk index (GNRI) and decoy receptor 3 (DcR3) have been shown as the nutritional and inflammatory markers, respectively. The present study aimed to assess the predictive ability of GNRI and DcR3 for PEW status and long-term outcomes in chronic hemodialysis patients.

METHODS

A prospective cohort of 318 hemodialysis patients was conducted with a median follow-up of 54 months. Malnutrition-inflammation score (MIS) was used as the reference standard for the presence of PEW. Endpoints were cardiovascular and all-cause mortality.

RESULTS

Baseline GNRI had a strong negative correlation with DcR3 and MIS score. For patients with age < or ≥60, high DcR3 and low GNRI were independent predictors for the presence of PEW at baseline. At the end of the study, 81 patients died (27 cardiovascular deaths). The adjusted hazard ratios (95% confidence intervals) of low GNRI and high DcR3 were 1.93 (1.1-4.8) and 2.53 (1.2-5.5) for cardiovascular mortality and 1.85 (1.1-3.2) and 2.37 (1.5-3.7) for all-cause mortality, respectively. While integrated into a model of conventional risk factors, GNRI together with DcR3 further significantly improved the predictability for overall mortality (c statistic, 0.823).

CONCLUSIONS

Low GNRI and high DcR3 were the alternatives for identifying hemodialysis patients at risk of PEW and overall mortality. Further studies are needed to verify whether timely recognition of hemodialysis patients with a high malnutrition-inflammation risk could reduce their mortality by appropriate interventional strategies.

Authors+Show Affiliations

Division of Nephrology, Taipei Veterans General Hospital, Taitung Branch, Taitung, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

25323840

Citation

Tsai, Ming-Tsun, et al. "Interaction Between Geriatric Nutritional Risk Index and Decoy Receptor 3 Predicts Mortality in Chronic Hemodialysis Patients." American Journal of Nephrology, vol. 40, no. 3, 2014, pp. 191-9.
Tsai MT, Hu FH, Lien TJ, et al. Interaction between geriatric nutritional risk index and decoy receptor 3 predicts mortality in chronic hemodialysis patients. Am J Nephrol. 2014;40(3):191-9.
Tsai, M. T., Hu, F. H., Lien, T. J., Chen, P. J., Huang, T. P., & Tarng, D. C. (2014). Interaction between geriatric nutritional risk index and decoy receptor 3 predicts mortality in chronic hemodialysis patients. American Journal of Nephrology, 40(3), 191-9. https://doi.org/10.1159/000366457
Tsai MT, et al. Interaction Between Geriatric Nutritional Risk Index and Decoy Receptor 3 Predicts Mortality in Chronic Hemodialysis Patients. Am J Nephrol. 2014;40(3):191-9. PubMed PMID: 25323840.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Interaction between geriatric nutritional risk index and decoy receptor 3 predicts mortality in chronic hemodialysis patients. AU - Tsai,Ming-Tsun, AU - Hu,Fen-Hsiang, AU - Lien,Tse-Jen, AU - Chen,Ping-Jen, AU - Huang,Tung-Po, AU - Tarng,Der-Cherng, Y1 - 2014/10/10/ PY - 2014/07/23/received PY - 2014/08/04/accepted PY - 2014/10/18/entrez PY - 2014/10/18/pubmed PY - 2015/7/21/medline SP - 191 EP - 9 JF - American journal of nephrology JO - Am J Nephrol VL - 40 IS - 3 N2 - BACKGROUND: Protein-energy wasting (PEW) is common and associated with poor outcome in hemodialysis patients. In hemodialysis patients, geriatric nutritional risk index (GNRI) and decoy receptor 3 (DcR3) have been shown as the nutritional and inflammatory markers, respectively. The present study aimed to assess the predictive ability of GNRI and DcR3 for PEW status and long-term outcomes in chronic hemodialysis patients. METHODS: A prospective cohort of 318 hemodialysis patients was conducted with a median follow-up of 54 months. Malnutrition-inflammation score (MIS) was used as the reference standard for the presence of PEW. Endpoints were cardiovascular and all-cause mortality. RESULTS: Baseline GNRI had a strong negative correlation with DcR3 and MIS score. For patients with age < or ≥60, high DcR3 and low GNRI were independent predictors for the presence of PEW at baseline. At the end of the study, 81 patients died (27 cardiovascular deaths). The adjusted hazard ratios (95% confidence intervals) of low GNRI and high DcR3 were 1.93 (1.1-4.8) and 2.53 (1.2-5.5) for cardiovascular mortality and 1.85 (1.1-3.2) and 2.37 (1.5-3.7) for all-cause mortality, respectively. While integrated into a model of conventional risk factors, GNRI together with DcR3 further significantly improved the predictability for overall mortality (c statistic, 0.823). CONCLUSIONS: Low GNRI and high DcR3 were the alternatives for identifying hemodialysis patients at risk of PEW and overall mortality. Further studies are needed to verify whether timely recognition of hemodialysis patients with a high malnutrition-inflammation risk could reduce their mortality by appropriate interventional strategies. SN - 1421-9670 UR - https://www.unboundmedicine.com/medline/citation/25323840/Interaction_between_geriatric_nutritional_risk_index_and_decoy_receptor_3_predicts_mortality_in_chronic_hemodialysis_patients_ L2 - https://www.karger.com?DOI=10.1159/000366457 DB - PRIME DP - Unbound Medicine ER -