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Impact of Annual Change in Geriatric Nutritional Risk Index on Mortality in Patients Undergoing Hemodialysis

1
Department of Nephrology, Matsunami General Hospital, Gifu 501-6062, Japan
2
Department of Internal Medicine, Matsunami General Hospital, Gifu 501-6062, Japan
3
Division of Medical Statistics, Fujita Health University School of Medicine, Aichi 470-1192, Japan
*
Author to whom correspondence should be addressed.
Nutrients 2020, 12(11), 3333; https://doi.org/10.3390/nu12113333
Received: 8 October 2020 / Revised: 26 October 2020 / Accepted: 27 October 2020 / Published: 29 October 2020
(This article belongs to the Section Nutritional Epidemiology)
Regular nutritional assessment may decrease the mortality rate in patients undergoing hemodialysis. This study aimed to evaluate whether annual change in geriatric nutritional risk index (ΔGNRI) can precisely predict mortality. We retrospectively examined 229 patients undergoing hemodialysis who measured geriatric nutritional risk index (GNRI). Patients were divided into four groups according to the baseline GNRI of 91.2, previously reported cutoff value, and declined or maintained GNRI during the first year (ΔGNRI < 0% vs. ΔGNRI ≥ 0%): Group 1 (G1), GNRI ≥ 91.2 and ΔGNRI ≥ 0%; G2, GNRI ≥ 91.2 and ΔGNRI < 0%; G3, GNRI < 91.2 and ΔGNRI ≥ 0%; and G4, GNRI < 91.2 and ΔGNRI < 0%. They were followed for mortality. During a median follow-up of 3.7 (1.9–6.9) years, 74 patients died, of which 35 had cardiovascular-specific causes. The GNRI significantly decreased from 94.8 ± 6.3 to 94.1 ± 6.7 in the first year (p = 0.035). ΔGNRI was negatively associated with baseline GNRI (ρ = −0.199, p = 0.0051). The baseline GNRI < 91.2 and ΔGNRI < 0% were independently associated with all-cause mortality (adjusted hazard ratio (aHR) 2.59, 95%, confidence interval (CI) 1.54–4.33, and aHR 2.33, 95% CI 1.32–4.32, respectively). The 10-year survival rates were 69.8%, 43.2%, 39.9%, and 19.2% in G1, G2, G3, and G4, respectively (p < 0.0001). The aHR value for G4 vs. G1 was 3.88 (95% CI 1.62–9.48). With regards to model discrimination, adding ΔGNRI to the baseline risk model including the baseline GNRI significantly improved the net reclassification improvement by 0.525 (p = 0.0005). With similar results obtained for cardiovascular mortality. We concluded that the ΔGNRI could not only predict all-cause and cardiovascular mortality but also improve predictability for mortality; therefore, GNRI might be proposed to be serially evaluated. View Full-Text
Keywords: hemodialysis; geriatric nutritional risk index (GNRI); annual change in GNRI (ΔGNRI); all-cause mortality; cardiovascular mortality hemodialysis; geriatric nutritional risk index (GNRI); annual change in GNRI (ΔGNRI); all-cause mortality; cardiovascular mortality
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MDPI and ACS Style

Yajima, T.; Yajima, K.; Takahashi, H. Impact of Annual Change in Geriatric Nutritional Risk Index on Mortality in Patients Undergoing Hemodialysis. Nutrients 2020, 12, 3333. https://doi.org/10.3390/nu12113333

AMA Style

Yajima T, Yajima K, Takahashi H. Impact of Annual Change in Geriatric Nutritional Risk Index on Mortality in Patients Undergoing Hemodialysis. Nutrients. 2020; 12(11):3333. https://doi.org/10.3390/nu12113333

Chicago/Turabian Style

Yajima, Takahiro, Kumiko Yajima, and Hiroshi Takahashi. 2020. "Impact of Annual Change in Geriatric Nutritional Risk Index on Mortality in Patients Undergoing Hemodialysis" Nutrients 12, no. 11: 3333. https://doi.org/10.3390/nu12113333

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