Synergistic Effects of the Geriatric Nutritional Risk Index and the Modified Creatinine Index for Predicting Mortality in Patients on Hemodialysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Data Collection
2.3. Calculation of Nutritional Indices and Patient Grouping
2.4. Statistical Analysis
3. Results
3.1. Baseline Characteristics of the Patients
3.2. Correlation between the GNRI and the mCI
3.3. Clinical Outcomes
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Total (N = 499) | G1 (N = 230) | G2 (N = 110) | G3 (N = 44) | G4 (N = 115) | p-Value | |
---|---|---|---|---|---|---|
Age, years | 65 (56–74) | 58 (49–65) | 72 (63–77) * | 64 (58–68) * | 73 (68–81) * | <0.05 |
Male sex, n (%) | 334 (67) | 189 (82) | 58 (53) | 34 (77) | 53 (46) | <0.05 |
Dialysis vintage, months | 64 (29–136) | 91 (45–154) | 38 (16–82) * | 93 (45–194) | 46 (18–106) * | <0.05 |
Presence of diabetes, n (%) | 185 (37) | 77 (33) | 53 (48) | 9 (20) | 46 (40) | <0.05 |
History of CVD, n (%) | 218 (44) | 84 (37) | 58 (53) | 17 (39) | 59 (51) | <0.05 |
Never smokers, n (%) | 253 (51) | 109 (47) | 61 (55) | 18 (41) | 65 (57) | 0.15 |
Presence of RKF, n (%) | 155 (31) | 58 (25) | 46 (42) | 7 (16) | 44 (38) | <0.05 |
Type of vascular access—AVF, n (%) | 464 (93) | 218 (95) | 102 (93) | 43 (98) | 101 (88) | 0.06 |
BMI, kg/m2 | 22 (19–24) | 23 (21–25) | 23 (21–24) | 19 (18–21) * | 19 (18–21) * | <0.05 |
Systolic blood pressure, mmHg | 155 (139–168) | 156 (140–167) | 159 (141–172) | 150 (136–171) | 152 (136–164) | 0.07 |
Single-pool Kt/V | 1.38 (1.25–1.53) | 1.37 (1.25–1.49) | 1.38 (1.23–1.54) | 1.39 (1.31–1.54) | 1.38 (1.24–1.57) | 0.61 |
Use of Antihypertensive drugs, n (%) | 370 (74) | 176 (77) | 82 (75) | 31 (70) | 81 (70) | 0.61 |
Use of RAS inhibitors, n (%) | 302 (61) | 148 (65) | 64 (58) | 28 (64) | 62 (54) | 0.25 |
Use of ESAs, n (%) | 445 (89) | 200 (87) | 101 (92) | 38 (86) | 106 (92) | 0.32 |
Use of P binders, n (%) | 407 (82) | 214 (93) | 75 (68) | 37 84) | 81 (70) | <0.05 |
Use of VDRAs, n (%) | 257 (52) | 123 (53) | 56 (51) | 21 (48) | 57 (50) | 0.85 |
Use of statins, n (%) | 59 (12) | 21 (9) | 22 (20) | 3 (7) | 13 (11) | <0.05 |
Hemoglobin, g/dL | 11.0 (10.3–11.8) | 11.0 (10.3–11.9) | 11.1 (10.5–11.9) | 11.2 (10.5–11.8) | 10.8 (9.9–11.6) * | <0.05 |
Serum albumin, g/dL | 3.7 (3.5–4.0) | 4.0 (3.7–4.1) | 3.8 (3.6–4.0) * | 3.5 (3.3–3.7) * | 3.3 (3.1–3.6) * | <0.05 |
Serum urea nitrogen, mg/dL | 65 (56–74) | 69 (62–78) | 59 (51–68) * | 69 (57–79) | 59 (47–70) * | <0.05 |
Serum creatinine, mg/dL | 10.8 (8.7–13.0) | 13.0 (11.8–14.5) | 8.6 (7.5–9.7) * | 12.1 (11.2–12.7) * | 8.2 (6.7–9.7) * | <0.05 |
Serum total cholesterol, mg/dL | 153 (132–178) | 152 (130–174) | 164 (139–183) * | 145 (123–174) | 151 (133–181) | <0.05 |
Corrected serum calcium, mg/dL | 9.4 (9.0–10.0) | 9.5 (9.0–9.9) | 9.2 (8.9–9.7) * | 9.7 (9.0–10.1) | 9.4 (9.0–10.2) | <0.05 |
Serum phosphate, mg/dL | 5.2 (4.5–6.0) | 5.5 (4.6–6.1) | 5.1 (4.4–5.9) | 5.2 (4.4–6.1) | 4.7 (4.0–5.7) * | <0.05 |
Serum intact PTH, pg/mL | 113 (48–191) | 134 (65–217) | 94 (51–182) * | 112 (30–169) | 86 (28–168) * | <0.05 |
Serum C-reactive protein, mg/dL | 0.09 (0.03–0.29) | 0.06 (0.03–0.18) | 0.10 (0.04–0.25) | 0.12 (0.05–0.40) * | 0.19 (0.05–0.78) * | <0.05 |
GNRI | 95 (90–100) | 98 (96–101) | 97 (94–100) * | 90 (86–91) * | 86 (83–89) * | <0.05 |
mCI, mg/kg/day | 21 (19–24) | 24 (22–26) | 19 (18–20) * | 23 (22–23) * | 19 (18–20) * | <0.05 |
Unadjusted Model | Multivariable Model 1 | Multivariable Model 2 | ||||
---|---|---|---|---|---|---|
Hazard Ratio (95% CI) | p-Value | Hazard Ratio (95% CI) | p-Value | Hazard Ratio (95% CI) | p-Value | |
GNRI | ||||||
High GNRI | 1.00 (reference) | - | 1.00 (reference) | - | 1.00 (reference) | - |
Low GNRI | 2.48 (1.78–3.45) | <0.05 | 1.48 (1.02–2.15) | <0.05 | 1.51 (1.03–2.20) | <0.05 |
mCI | ||||||
High mCI | 1.00 (reference) | - | 1.00 (reference) | - | 1.00 (reference) | - |
Low mCI | 3.28 (2.30–4.69) | <0.05 | 1.67 (1.09–2.58) | <0.05 | 1.82 (1.17–2.82) | <0.05 |
Unadjusted Model | Multivariable Model 1 | Multivariable Model 2 | ||||
---|---|---|---|---|---|---|
Hazard Ratio (95% CI) | p-Value | Hazard Ratio (95% CI) | p-Value | Hazard Ratio (95%CI) | p-Value | |
All-cause mortality | ||||||
G1 | 1.00 (reference) | - | 1.00 (reference) | - | 1.00 (reference) | - |
G2 | 2.61 (1.65–4.12) | <0.05 | 1.39 (0.83–2.31) | 0.21 | 1.50 (0.89–2.51) | 0.13 |
G3 | 1.55 (0.75–3.23) | 0.24 | 1.02 (0.48–2.16) | 0.96 | 1.01 (0.47–2.15) | 0.98 |
G4 | 4.65 (3.06–7.07) | <0.05 | 2.10 (1.25–3.52) | <0.05 | 2.31 (1.36–3.89) | <0.05 |
Cardiovascular mortality | ||||||
G1 | 1.00 (reference) | - | 1.00 (reference) | - | 1.00 (reference) | - |
G2 | 2.74 (1.41–5.32) | <0.05 | 1.45 (0.68–3.02) | 0.33 | 1.62 (0.76–3.46) | 0.21 |
G3 | 1.49 (0.50–4.47) | 0.47 | 1.00 (0.33–3.80) | 1.00 | 1.00 (0.32–3.07) | 0.99 |
G4 | 4.20 (2.24–7.88) | <0.05 | 1.83 (0.85–3.98) | 0.12 | 2.12 (0.96–4.68) | 0.06 |
Infection-related mortality | ||||||
G1 | 1.00 (reference) | - | 1.00 (reference) | - | 1.00 (reference) | - |
G2 | 2.69 (0.97–7.41) | 0.06 | 1.10 (0.35–3.41) | 0.87 | 1.23 (0.39–3.89) | 0.72 |
G3 | 3.46 (1.01–11.81) | 0.05 | 2.07 (0.57–7.52) | 0.27 | 2.00 (0.55–7.30) | 0.29 |
G4 | 6.67 (2.76–16.11) | <0.05 | 2.67 (0.91–7.77) | 0.77 | 2.95 (1.00–8.70) | <0.05 |
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Naito, T.; Doi, T.; Morii, K.; Usui, K.; Arita, M.; Yamashita, K.; Shigemoto, K.; Nishizawa, Y.; Mizuiri, S.; Sasaki, K.; et al. Synergistic Effects of the Geriatric Nutritional Risk Index and the Modified Creatinine Index for Predicting Mortality in Patients on Hemodialysis. Nutrients 2022, 14, 2398. https://doi.org/10.3390/nu14122398
Naito T, Doi T, Morii K, Usui K, Arita M, Yamashita K, Shigemoto K, Nishizawa Y, Mizuiri S, Sasaki K, et al. Synergistic Effects of the Geriatric Nutritional Risk Index and the Modified Creatinine Index for Predicting Mortality in Patients on Hemodialysis. Nutrients. 2022; 14(12):2398. https://doi.org/10.3390/nu14122398
Chicago/Turabian StyleNaito, Takayuki, Toshiki Doi, Kenichi Morii, Koji Usui, Michiko Arita, Kazuomi Yamashita, Kenichiro Shigemoto, Yoshiko Nishizawa, Sonoo Mizuiri, Kensuke Sasaki, and et al. 2022. "Synergistic Effects of the Geriatric Nutritional Risk Index and the Modified Creatinine Index for Predicting Mortality in Patients on Hemodialysis" Nutrients 14, no. 12: 2398. https://doi.org/10.3390/nu14122398