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Comparison of Nutritional Risk Scores for Predicting Mortality in Japanese Chronic Hemodialysis Patients.
J Ren Nutr. 2017 05; 27(3):201-206.JR

Abstract

OBJECTIVE

Protein energy wasting (PEW) is consistently associated with poor prognosis in hemodialysis (HD) patients. We compared the predictability of PEW as diagnosed by The International Society of Renal Nutrition and Metabolism criteria (PEWISRNM) and geriatric nutritional risk index (GNRI) for all-cause mortality in Japanese HD patients. As cut-off values for body mass index (BMI) for PEW have not been established in PEWISRNM for Asian populations, these were also investigated.

DESIGN AND SUBJECTS

The nutritional status from 409 HD patients was evaluated according to ISRNM and GNRI criteria. To compare the predictability of mortality, C-index, net reclassification improvement (NRI) and integrated discrimination improvement were evaluated.

RESULTS

During follow-up (median, 52 months; range, 7 months), 70 patients (17.1%) presented PEW according to ISRNM and 131 patients (32.1%) according to GNRI; in addition, 101 patients (24.7%) died. PEWISRNM and GNRI were identified as independent predictors of death. Addition of PEWISRNM and GNRI to a predictive model based on established risk factors improved NRI and integrated discrimination improvement. However, no differences were found between models including PEWISRNM and GNRI. When lowering the criterion level of BMI per 1 kg/m2 sequentially, PEWISRNM at BMI <20 kg/m2 maximized the hazard ratio for mortality. The model including PEWISRNM at BMI <20 kg/m2 improved NRI compared with the model including GNRI.

CONCLUSION

PEWISRNM and GNRI represent independent predictors of mortality, with comparable predictability. The diagnostic criterion of BMI in the ISRNM for Japanese population might be better at <20 kg/m2 than at <23 kg/m2.

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Authors+Show Affiliations

Takahashi H
Department of Nephrology, School of Medicine, Fujita Health University, Toyoake, Japan.
Inoue K
Department of Nutrition, Faculty of Wellness, Shigakkan University, Obu, Japan.
Shimizu K
Department of Nutrition, Hakuyokai Hospital, Nagoya, Japan.
Hiraga K
Department of Nutrition, Shinseikai-Daiichi Hospital, Nagoya, Japan.
Takahashi E
Department of Nutrition, Kaikokai-Central Clinic, Nagoya, Japan.
Otaki K
Department of Nutrition, Daiyukai Daiichi Hospital, Ichinomiya, Japan.
Yoshikawa T
Department of Nutrition, Medical Satellite Nagoya, Nagoya, Japan.
Furuta K
Department of Nutrition, Tajimi Clinic, Tajimi, Japan.
Tokunaga C
Department of Nutrition, Suzuka Kidney Clinic, Suzuka, Japan.
Sakakibara T
Department of Nutrition, Kaikokai-Central Clinic, Nagoya, Japan.
Ito Y
Department of Nephrology and Renal Replacement Therapy, Graduate School of Medicine, Nagoya University, Nagoya, Japan. Electronic address: yasuito@med.nagoya-u.ac.jp.
Tokai Renal Nutrition Study Group
No affiliation info available

MeSH

AgedAsian Continental Ancestry GroupBody Mass IndexDietDietary ProteinsFemaleFollow-Up StudiesGeriatric AssessmentHumansJapanKidney Failure, ChronicMaleMiddle AgedNutrition AssessmentNutritional StatusPrognosisProportional Hazards ModelsProtein-Energy MalnutritionRenal DialysisRisk FactorsSerum Albumin

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28215493

Citation

Takahashi, Hiroshi, et al. "Comparison of Nutritional Risk Scores for Predicting Mortality in Japanese Chronic Hemodialysis Patients." Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, vol. 27, no. 3, 2017, pp. 201-206.
Takahashi H, Inoue K, Shimizu K, et al. Comparison of Nutritional Risk Scores for Predicting Mortality in Japanese Chronic Hemodialysis Patients. J Ren Nutr. 2017;27(3):201-206.
Takahashi, H., Inoue, K., Shimizu, K., Hiraga, K., Takahashi, E., Otaki, K., Yoshikawa, T., Furuta, K., Tokunaga, C., Sakakibara, T., & Ito, Y. (2017). Comparison of Nutritional Risk Scores for Predicting Mortality in Japanese Chronic Hemodialysis Patients. Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, 27(3), 201-206. https://doi.org/10.1053/j.jrn.2016.12.005
Takahashi H, et al. Comparison of Nutritional Risk Scores for Predicting Mortality in Japanese Chronic Hemodialysis Patients. J Ren Nutr. 2017;27(3):201-206. PubMed PMID: 28215493.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of Nutritional Risk Scores for Predicting Mortality in Japanese Chronic Hemodialysis Patients. AU - Takahashi,Hiroshi, AU - Inoue,Keiko, AU - Shimizu,Kazue, AU - Hiraga,Keiko, AU - Takahashi,Erika, AU - Otaki,Kaori, AU - Yoshikawa,Taeko, AU - Furuta,Kumiko, AU - Tokunaga,Chika, AU - Sakakibara,Tomoyo, AU - Ito,Yasuhiko, AU - ,, Y1 - 2017/02/20/ PY - 2016/09/15/received PY - 2016/12/11/revised PY - 2016/12/13/accepted PY - 2017/2/22/pubmed PY - 2017/10/4/medline PY - 2017/2/21/entrez SP - 201 EP - 206 JF - Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation JO - J Ren Nutr VL - 27 IS - 3 N2 - OBJECTIVE: Protein energy wasting (PEW) is consistently associated with poor prognosis in hemodialysis (HD) patients. We compared the predictability of PEW as diagnosed by The International Society of Renal Nutrition and Metabolism criteria (PEWISRNM) and geriatric nutritional risk index (GNRI) for all-cause mortality in Japanese HD patients. As cut-off values for body mass index (BMI) for PEW have not been established in PEWISRNM for Asian populations, these were also investigated. DESIGN AND SUBJECTS: The nutritional status from 409 HD patients was evaluated according to ISRNM and GNRI criteria. To compare the predictability of mortality, C-index, net reclassification improvement (NRI) and integrated discrimination improvement were evaluated. RESULTS: During follow-up (median, 52 months; range, 7 months), 70 patients (17.1%) presented PEW according to ISRNM and 131 patients (32.1%) according to GNRI; in addition, 101 patients (24.7%) died. PEWISRNM and GNRI were identified as independent predictors of death. Addition of PEWISRNM and GNRI to a predictive model based on established risk factors improved NRI and integrated discrimination improvement. However, no differences were found between models including PEWISRNM and GNRI. When lowering the criterion level of BMI per 1 kg/m2 sequentially, PEWISRNM at BMI <20 kg/m2 maximized the hazard ratio for mortality. The model including PEWISRNM at BMI <20 kg/m2 improved NRI compared with the model including GNRI. CONCLUSION: PEWISRNM and GNRI represent independent predictors of mortality, with comparable predictability. The diagnostic criterion of BMI in the ISRNM for Japanese population might be better at <20 kg/m2 than at <23 kg/m2. SN - 1532-8503 UR - https://www.unboundmedicine.com/medline/citation/28215493/Comparison_of_Nutritional_Risk_Scores_for_Predicting_Mortality_in_Japanese_Chronic_Hemodialysis_Patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1051-2276(16)30191-1 DB - PRIME DP - Unbound Medicine ER -