タグ: Geriatric Nutritional Risk Index

Geriatric Nutritional Risk Index, a simplified nutritional screening index, is a significant predictor of mortality in chronic dialysis patients

Zadeh has reported that malnutrition-Inflammation Score (MIS) is predictor of mortality in hemodialysis patients. Although Yamada has reported that the significant correlation between Geriatric Nutritional Risk Index (GNRI) and MIS, they did not report the correlation between GNRI and mortality in chronic hemodialysis patients. This article has reported that GNRI is significant predictor of mortality in chronic dialysis patients.

Geriatric Nutritional Risk Index, a simplified nutritional screening index, is a significant predictor of mortality in chronic dialysis patients

Ikue Kobayashi, Eiji Ishimura, Yoko Kato, Senji Okuno, Tadashi Yamamoto, Tomoyuki Yamakawa, Katsuhito Mori, Masaaki Inaba and Yoshiki Nishizawa

Nephrol Dial Transplant (2010) 25: 3361-3365

Abstract

Background

Malnutrition is a common complication in haemodialysis patients. Recently, the Geriatric Nutritional Risk Index (GNRI) has been reported as a simple and accurate tool to assess nutritional status of haemodialysis patients. Our objective was to examine the association between GNRI and mortality in chronic haemodialysis patients.

Methods

We examined the GNRI of 490 maintenance haemodialysis patients (60 ± 12 years, 293 males and 197 females) and followed up these patients for 60 months. Predictors for all-cause death were examined using Kaplan–Meier analysis and Cox proportional analyses.

Results

The GNRI was 98.0 ± 6.0, and was significantly and negatively correlated with age and haemodialysis duration. During the 60-month follow-up period, 129 patients died. According to the highest positive likelihood and risk ratios, the cutoff value of GNRI for mortality was set at 90. Kaplan–Meier analysis revealed that patients with a GNRI <90 (n = 50) had a significantly lower survival rate, compared to those with GNRI ≥90 (n = 440) (log-rank test, P < 0.0001). Multivariate Cox proportional hazards analyses demonstrated that GNRI was a significant predictor for mortality [hazard ratio (HR) 0.962, 95% confidence interval (CI) 0.931–0.995, P < 0.05], after adjustment for age, gender, C-reactive protein, presence of diabetes and haemodialysis duration.

Conclusions

These results demonstrated that GNRI is a significant predictor for mortality in haemodialysis patients. The simple method of GNRI is considered to be a clinically useful marker for the assessment of nutritional status in haemodialysis patients.

Keywords: Geriatric Nutritional Risk Index; haemodialysis; malnutrition; mortality

Geriatric Nutritional Risk Indexは簡易栄養スクリーニング指標であるが，維持透析患者の死亡率の有意な指標である

　維持透析患者の MIS と死亡率との相関 Zadeh らが報告し，GNRI と MIS との相関の強さは Yamada が報告しておりますが，Yamada の報告では GNRI と透析患者の死亡率との比較はありませんでした．この論文は GNRI と透析患者の死亡率とを直接比較した報告です．

Geriatric Nutritional Risk Indexは簡易栄養スクリーニング指標であるが，維持透析患者の死亡率の有意な指標である

Ikue Kobayashi, Eiji Ishimura, Yoko Kato, Senji Okuno, Tadashi Yamamoto, Tomoyuki Yamakawa, Katsuhito Mori, Masaaki Inaba and Yoshiki Nishizawa

Nephrol Dial Transplant (2010) 25: 3361-3365

要旨

背景

　低栄養は透析患者の一般的合併症である．最近 Geriatric Nutritional Risk Index (GNRI) が透析患者の栄養状態を簡易で正確に評価するツールとして報告されるようになってきた．我々の研究では透析患者の GNRI と死亡率との相関を調査した．

方法

　我々は 490 名の維持透析患者 (60 ± 12 歳，男性 293 名，女性 197 名) の GNRI を調査し，60 ヶ月間に渡って経過を観察した．全死亡の指標を Kaplan-Meyer 法と Cox 比例ハザード法で検証した．

結果

　GNRI は98.0 ± 6.0 であり，有意に年齢および透析期間と負の相関があった．60 ヶ月間の観察期間中 129 名が死亡した．死亡を鑑別する GNRI の陽性尤度比が最大となるカットオフ値は 90 であった．Kaplan-Meyer 法によると GNRI 90 未満の患者 (n = 50) の生存率は 90 以上の患者 (n = 440) と比較して有意に低かった(log-rank検定p < 0.0001)．多変量の Cox 比例ハザード解析ではGNRI が死亡率の有意な指標となることが明らかとなった（年齢，性別，CRP, 糖尿病の存在および透析期間で調整後のハザード比 0.962, 95%CI 0.931 – 0.995, p < 0.05）．

結論

　これらの結果は GNRI が透析患者の死亡率の有意な指標であることを示している．この GNRI の簡易な手法は透析患者の栄養状態を評価する臨床的に有用なマーカーであると考えられる．

キーワード：Geriatric Nutritional Risk Index; haemodialysis; malnutrition; mortality

Simplified nutritional screening tools for patients on maintenance hemodialysis

I read the paper below, which describes that MIS is best criteria for assessment of nutrition status of hemodialysis patients. But the method is time-consuming and needs skill. The GNRI is most simple method using only serum albumin, height and body weight for assessment them.

Simplified nutritional screening tools for patients on maintenance hemodialysis

Kohsuke Yamada, Ryuichi Furuya, Takako Takita, Yukitaka Maruyama, Yuri Yamaguchi, Sakae Ohkawa and Hiromichi Kumagai

1 From the Department of Clinical Nutrition, School of Food and Nutritional Sciences and the COE Program in the 21st Century, University of Shizuoka, Shizuoka, Japan (KY, YY, SO, and HK); the Renal Division, Department of Internal Medicine, Iwata City Hospital, Iwata, Shizuoka, Japan (RF); and the Maruyama Hospital, Hamamatsu, Japan (TT and YM)

Background:

Malnutrition is a prevalent complication in patients on maintenance hemodialysis. Nutritional screening tools may be useful to identify those patients at nutritional risk from among hundreds of hemodialysis patients in a large facility.

Objective:

We tested several simplified nutritional screening tools on hemodialysis patients to validate the potential application of the tools.

Design:

The simplified nutritional screening tools were chosen from references published between 1985 and 2005. Nutritional assessments, including history taking, and anthropometric and biochemical measurements were performed on 422 hemodialysis patients. These results were applied to obtain the score of each nutritional screening tool and the malnutrition-inflammation score (MIS), a comprehensive nutritional assessment tool, as the reference standard. The usefulness of each nutritional screening tool for identifying nutritional risk was assessed by comparison with the MIS value and various individual nutritional measures.

Results:

Five reliable nutritional screening tools were found by the literature search. Among them, the geriatric nutritional risk index (GNRI) was considered to be the most accurate in identifying hemodialysis patients at nutritional risk, because the area under the receiver operating characteristic curve generated with the MIS value was the largest. The GNRI showed a significantly negative correlation with the MIS (r = –0.67, P < 0.0001), and the most accurate GNRI cutoff to identify a malnourished patient according to the MIS was <91.2. The GNRI's sensitivity, specificity, and accuracy of <91.2 in predicting malnutrition according to the MIS were 0.730, 0.819, and 0.787, respectively.

Conclusion:

The GNRI was the simplest and most accurate risk index for identifying hemodialysis patients at nutritional risk according to the MIS.

Key Words:

Geriatric nutritional risk index • hemodialysis • nutritional assessment • nutritional screening • malnutrition-inflammation score • nutritional risk