A Low Geriatric Nutrition Risk Index Is Associated with Progression to Dialysis in Patients with Chronic Kidney Disease
Abstract
:1. Introduction
2. Subjects and Methods
2.1. Study Patients and Design
2.2. Evaluation of Cardiac Structure and Function
2.3. GNRI Calculation
2.4. Collection of Demographic, Medical, and Laboratory Data
2.5. Definition of Renal End-Point
2.6. Statistical Analysis
3. Results
3.1. Correlation between GNRI and Echocardiographic Parameters
3.2. Determinants of GNRI
3.3. Risk of Progression to Dialysis
3.4. Comparison of Albumin, BMI and GNRI in Progression to Dialysis
4. Discussion
Author Contributions
Conflicts of Interest
References
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Characteristics | Tertile 1 (n = 166) | Tertile 2 (n = 166) | Tertile 3 (n = 164) | p | All Patients (n = 496) |
---|---|---|---|---|---|
GNRI (score) | 95.4 ± 9.8 | 108.3 ± 2.0 * | 117.4 ± 5.9 *,† | <0.001 | 107.2 ± 11.4 |
Age (year) | 68.0 ± 11.6 | 67.3 ± 11.8 | 63.6 ± 12.7 *,† | 0.002 | 66.3 ± 12.2 |
Male gender (%) | 62.7 | 62.7 | 65.2 | 0.854 | 63.5 |
Smoking history (%) | 34.5 | 28.9 | 29.9 | 0.447 | 31.3 |
Diabetes mellitus (%) | 54.2 | 54.8 | 59.1 | 0.618 | 56.0 |
Hypertension (%) | 78.9 | 81.3 | 87.2 | 0.127 | 82.5 |
Coronary artery disease (%) | 6.6 | 12.7 | 14.6 | 0.057 | 11.3 |
Cerebrovascular disease (%) | 16.3 | 15.7 | 13.4 | 0.750 | 15.1 |
Systolic blood pressure (mmHg) | 141.7 ± 25.5 | 140.2 ± 19.5 | 141.9 ± 18.0 | 0.729 | 141.3 ± 21.2 |
Diastolic blood pressure (mmHg) | 77.9 ± 13.6 | 78.3 ± 11.7 | 81.3 ± 12.8 | 0.031 | 79.2 ± 12.8 |
Body mass index (kg/m2) | 21.9 ± 2.7 | 25.2 ± 2.3 * | 28.9 ± 3.2 *,† | <0.001 | 25.3 ± 4.0 |
Laboratory parameters | |||||
Albumin (g/dL) | 3.73 ± 0.44 | 4.07 ± 0.28 * | 4.24 ± 0.26 *,† | <0.001 | 4.01 ± 0.40 |
Fasting glucose (mg/dL) | 121.0 ± 52.3 | 126.5 ± 60.2 | 131.6 ± 62.4 | 0.259 | 126.4 ± 58.5 |
Triglyceride (mg/dL) | 116 (82–177) | 134.5 (103–199.8) | 159 (107–225) * | <0.001 | 137.5 (96–201) |
Total cholesterol (mg/dL) | 192.0 ± 51.7 | 195.3 ± 45.2 | 194.5 ± 45.6 | 0.812 | 194.0 ± 47.5 |
Hemoglobin (g/dL) | 10.6 ± 2.2 | 11.7 ± 2.2 * | 12.6 ± 2.1 *,† | <0.001 | 11.6 ± 2.3 |
eGFR (mL/min/1.73 m2) | 21.9 ± 13.5 | 26.7 ± 14.1 * | 29.7 ± 14.0 * | <0.001 | 26.1 ± 14.2 |
CaXP product (mg2/dL2) | 39.2 ± 8.5 | 38.0 ± 9.5 | 97.9 ± 8.0 | 0.332 | 38.3 ± 8.7 |
Uric acid (mg/dL) | 8.0 ± 2.6 | 8.2 ± 2.0 | 8.4 ± 2.1 | 0.161 | 8.2 ± 2.2 |
Proteinuria (%) | 75.8 | 61.2 * | 61.6 * | 0.006 | 66.2 |
Echocardiographic data | |||||
LVEDV (mL) | 112.6 ± 39.9 | 114.7 ± 38.1 | 119.4 ± 40.4 | 0.279 | 115.6 ± 39.5 |
LVESV (mL) | 39.2 ± 26.5 | 38.1 ± 20.9 | 37.9 ± 27.8 | 0.875 | 38.4 ± 25.2 |
LAD > 4.7 cm (%) | 6.0 | 7.2 | 6.1 | 0.883 | 6.5 |
LVMI (g/m2) | 150.2 ± 56.1 | 135.3 ± 45.7 * | 140.2 ± 47.3 | 0.022 | 141.9 ± 50.2 |
LVH (%) | 65.7 | 55.4 | 56.7 | 0.118 | 59.3 |
LVEF (%) | 67.0 ± 12.8 | 68.3 ± 9.7 | 69.7 ± 9.5 * | 0.081 | 68.3 ± 10.8 |
LVEF < 50% (%) | 10.2 | 4.2 | 2.4 * | 0.005 | 5.6 |
Echocardiographic Parameters | Pearson’s r | p |
---|---|---|
LVEDV (mL) | 0.033 | 0.463 |
LVESV (mL) | −0.049 | 0.275 |
LAD > 4.7 cm (%) | −0.007 | 0.874 |
LVMI (g/m2) | −0.116 | 0.001 |
LVH (%) | −0.095 | 0.035 |
LVEF (%) | 0.111 | 0.014 |
LVEF < 50% (%) | −0.138 | 0.002 |
Parameter | Univariable | Multivariable | ||
---|---|---|---|---|
Unstandardized Coefficient β (95% CI) | p | Unstandardized Coefficient β | p | |
Age (per 1 year) | −0.137 (−0.219, −0.055) | 0.001 | −0.097 (−0.176, −0.018) | 0.017 |
Male versus female | −0.508 (−2.600, 1.583) | 0.633 | – | – |
Smoking history | −1.174 (−3.344, 0.997) | 0.289 | – | – |
Diabetes mellitus | 0.599 (−1.430, 2.628) | 0.562 | – | – |
Hypertension | 2.666 (0.028, 5.304) | 0.048 | 1.898 (−0.689, 4.486) | 0.150 |
Coronary artery disease | 4.066 (0.904, 7.229) | 0.012 | 3.912 (0.919, 6.905) | 0.011 |
Cerebrovascular disease | −1.318 (−4.127, 1.491) | 0.357 | – | – |
Systolic blood pressure (per 1 mmHg) | −0.013 (−0.062, 0.037) | 0.502 | – | – |
Diastolic blood pressure (per 1 mmHg) | 0.076 (−0.005, 0.157) | 0.065 | – | – |
Laboratory parameters | ||||
Fasting glucose (per 1 mg/dL) | 0.007 (−0.011, 0.024) | 0.435 | – | – |
Triglyceride (per log 1 mg/dL) | 9.154 (5.061, 13.248) | <0.001 | 6.672 (2.687, 10.657) | 0.001 |
Total cholesterol (per 1 mg/dL) | 0.013 (−0.009, 0.034) | 0.242 | – | – |
Hemoglobin (per 1 g/dL) | 1.548 (1.141, 1.956) | <0.001 | 1.343 (0.775, 1.910) | <0.001 |
eGFR (per 1 mL/min/1.73 m2) | 0.165 (0.096, 0.235) | <0.001 | 0.003 (−0.101, 0.107) | 0.954 |
CaXP product (per 1 mg2/dL2) | −0.089 (−0.207, 0.208) | 0.136 | – | – |
Uric acid (per 1 mg/dL) | 0.197 (−0.253, 0.648) | 0.390 | – | – |
Proteinuria | −2.578 (−4.702, −0.455) | 0.017 | −1.037 (−3.506, 1.432) | 0.409 |
Echocardiographic data | ||||
LVEDV (per 1 mL) | 0.010 (−0.016, 0.035) | 0.463 | – | – |
LVESV (per 1 mL) | −0.022 (−0.062, 0.018) | 0.275 | – | – |
LAD > 4.7 cm | −0.332 (−4.432, 3.768) | 0.874 | – | – |
LVH | −2.199 (−4.239, −0.158) | 0.035 | −0.345 (−2.392, 1.703) | 0.741 |
LVEF < 50% | −0.832 (−11.154, −2.509) | 0.002 | −5.261 (−9.531, −0.991) | 0.016 |
Parameter | Univariable | |
---|---|---|
HR (95% CI) | p | |
GNRI (per 1 score) | 0.966 (0.958–0.977) | <0.001 |
Age (per 1 year) | 0.988 (0.973–1.004) | 0.137 |
Male versus female | 0.520 (0.354–0.762) | 0.001 |
Smoking (ever versus never) | 1.049 (0.695–1.585) | 0.819 |
Diabetes mellitus | 1.796 (1.193–2.704) | 0.005 |
Hypertension | 2.863 (1.392–5.888) | 0.004 |
Coronary artery disease | 1.413 (0.818–2.441) | 0.215 |
Cerebrovascular disease | 1.255 (0.755–2.086) | 0.381 |
Systolic blood pressure (per 1 mmHg) | 1.025 (1.017–1.033) | <0.001 |
Diastolic blood pressure (per 1 mmHg) | 0.998 (0.983–1.013) | 0.793 |
Laboratory parameters | ||
Fasting glucose (per 1 mg/dL) | 1.003 (1.001–1.006) | 0.017 |
Triglyceride (per log 1 mg/dL) | 1.017 (0.453–2.284) | 0.968 |
Cholesterol (per 1 mg/dL) | 1.001 (0.997–1.006) | 0.512 |
Hemoglobin (per 1 g/dL) | 0.595 (0.539–0.657) | <0.001 |
eGFR (per 1 mL/min/1.73 m2) | 0.844 (0.817–0.872) | <0.001 |
CaXP product (per 1 mg2/dL2) | 1.070 (1.056–1.085) | <0.001 |
Uric acid (per 1 mg/dL) | 1.106 (1.011–1.213) | 0.028 |
Proteinuria | 15.015 (5.527–40.787) | <0.001 |
LAD > 4.7 cm | 2.298 (1.285–4.109) | 0.005 |
LVH | 4.234 (2.486–7.210) | <0.001 |
LVEF < 50% | 1.532 (0.744–3.157) | 0.247 |
Parameter | Multivariable: Model 1 | Multivariable: Model 2 | ||
---|---|---|---|---|
HR (95% CI) | p | HR (95% CI) | p | |
GNRI (per 1 score) | 0.965 (0.955–0.976) | <0.001 | 0.975 (0.963–0.987) | <0.001 |
Male versus female | 0.565 (0.383–0.832) | 0.004 | ||
Diabetes mellitus | 1.508 (0.988–2.304) | 0.057 | ||
Hypertension | 1.986 (0.951–4.149) | 0.068 | ||
Systolic blood pressure (per 1 mmHg) | 1.021 (1.012–1.029) | <0.001 | ||
Laboratory parameters | ||||
Fasting glucose (per 1 mg/dL) | 1.003 (1.001–1.006) | 0.017 | ||
Hemoglobin (per 1 g/dL) | 0.885 (0.770–1.018) | 0.087 | ||
eGFR (per 1 mL/min/1.73 m2) | 0.875 (0.838–0.913) | <0.001 | ||
CaXP product (per 1 mg2/dL2) | 1.018 (0.996–1.040) | 0.111 | ||
Uric acid (per 1 mg/dL) | 1.046 (0.934–1.171) | 0.436 | ||
Proteinuria | 2.991 (0.702–12.750) | 0.139 | ||
LAD > 4.7 cm | 1.412 (0.741–2.691) | 0.294 | ||
LVH | 1.583 (0.914–2.743) | 0.101 |
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Kuo, I.-C.; Huang, J.-C.; Wu, P.-Y.; Chen, S.-C.; Chang, J.-M.; Chen, H.-C. A Low Geriatric Nutrition Risk Index Is Associated with Progression to Dialysis in Patients with Chronic Kidney Disease. Nutrients 2017, 9, 1228. https://doi.org/10.3390/nu9111228
Kuo I-C, Huang J-C, Wu P-Y, Chen S-C, Chang J-M, Chen H-C. A Low Geriatric Nutrition Risk Index Is Associated with Progression to Dialysis in Patients with Chronic Kidney Disease. Nutrients. 2017; 9(11):1228. https://doi.org/10.3390/nu9111228
Chicago/Turabian StyleKuo, I-Ching, Jiun-Chi Huang, Pei-Yu Wu, Szu-Chia Chen, Jer-Ming Chang, and Hung-Chun Chen. 2017. "A Low Geriatric Nutrition Risk Index Is Associated with Progression to Dialysis in Patients with Chronic Kidney Disease" Nutrients 9, no. 11: 1228. https://doi.org/10.3390/nu9111228