A Comparison of 8 Nutrition-Related Tests to Predict Mortality in Hemodialysis Patients

Zuijdewijn, Camiel L M de Roij van; Wee, Piet M. ter; Chapdelaine, Isabelle; Bots, Michiel L.; Blankestijn, Peter J.; Dorpel, Marinus A. van den; Nubé, Menso J.; Grooteman, Muriël P.C.

doi:10.1053/j.jrn.2015.02.005

Cited by 56 publications

(51 citation statements)

References 45 publications

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“…Their results have been further confirmed by subsequent studies, especially from Asian chronic HD patients [8,11,21]. Besides that, studies from Italy, Netherlands and French also got similar conclusion [10,28,37]. Recently, a prospective cohort study with a total of 3436 Japanese HD participants included, Matsukuma et al demonstrated that lower GNRI levels are an independent risk factor for infection-related mortality and all-cause mortality in patients undergoing HD [32].…”

Section: Discussionmentioning

confidence: 71%

Association of Geriatric Nutritional Risk Index with Mortality in Hemodialysis Patients: A Meta-Analysis of Cohort Studies

Xiong

Min

Zhang

et al. 2018

Kidney Blood Press Res

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Background/Aims: Geriatric nutritional risk index (GNRI) was developed as a “nutrition-related” risk index and was reported in different populations as associated with the risk of all-cause and cardiovascular morbidity and mortality. Therefore, GNRI can be used to classify patients according to a risk of complications in relation to conditions associated with protein-energy wasting (PEW). However, not all reports pointed to the prognostic ability of the GNRI. The purpose of this study was to assess the associations of GNRI with mortality in chronic hemodialysis patients. Methods: We electronically searched original articles published in peer-reviewed journals from their inception to September 2018 in The PubMed, Embase, and the Cochrane Library databases. The primary outcome was all-cause and cardiovascular mortality. We pooled unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) using Review Manager 5.3 software. Results: A total of 10,739 patients from 19 cohort studies published from 2010 to 2018 were included. A significant negative association was found between the GNRI and all-cause mortality in patients with chronic hemodialysis (OR, 0.90; 95% CI, 0.84-0.97, p=0.004) (per unit increase) and (OR, 2.15; 95% CI, 1.88-2.46, p＜0.00001) (low vs. high GNRI). Moreover, there was also a significant negative association between the GNRI (per unit increase) and cardiovascular events (OR, 0.98; 95% CI, 0.97-1.00, p=0.01), as well as cardiovascular mortality (OR, 0.89; 95% CI, 0.80-0.99, p=0.03). Conclusion: Our findings supported the hypothesis that the low GNRI is associated with an increased risk of all-cause and cardiovascular mortality in chronic hemodialysis patients. Based on our literature review, GNRI has been found to be an effective tool for identifying patients with nutrition-related risk of all-cause and cardiovascular disease.

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Section: Discussionmentioning

confidence: 71%

Association of Geriatric Nutritional Risk Index with Mortality in Hemodialysis Patients: A Meta-Analysis of Cohort Studies

Xiong

Min

Zhang

et al. 2018

Kidney Blood Press Res

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“…Serum albumin captures decline in visceral protein stores and has been shown to discriminate for allcause mortality in HD patients similarly to Subjective Global Assessment, Malnutrition Inflammation Score, and Geriatric Nutritional Risk Index [15].…”

Section: Introductionmentioning

confidence: 99%

Malnutrition Risk in Hemodialysis Patients in Israel: Results of the Status of Nutrition In Hemodialysis Patients Survey Study

Boaz

Azoulay

Schwartz

et al. 2019

Nephron

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Background: Malnutrition is a frequently observed disorder in patients with chronic kidney disease (CKD) receiving hemodialysis (HD). While variously defined, malnutrition is a frequently observed condition among patients on HD. Prevalence estimates of malnutrition among Israeli HD patients have not been reported. Objectives: To survey nutrition intake in Israeli HD patients; estimate malnutrition risk prevalence; identify risk factors, and characterize malnutrition risk in HD patients. Methods: A representative sample of 378 Israeli HD patients treated in hospital HD centers throughout the country were surveyed. Using the 24-h recall method, dietary intake was estimated and the chronologically corresponding biochemistry, anthropometric, and hemodynamic measures were recorded. Four categories of malnutrition risk were defined: “minimal”: body mass index (BMI) > 23 kg/m² and serum albumin > 3.8 g/dL; “mild”: BMI < 23 kg/m² and albumin > 3.8 g/dL; “moderate”: BMI > 23 kg/m² and albumin < 3.8 g/dL; “severe”: BMI < 23 k/m² and serum albumin < 3.8 g/dL. Results: Elevated malnutrition risk was identified in 175 (46.3%) study participants, who were more likely to require feeding assistance, have major comorbidities, reduced hemoglobin, and elevated C-reactive protein. Oral nutrition supplementation was prescribed to only 14.3% of patients with elevated malnutrition risk. Intradialytic parenteral nutrition was recorded for 6 patients, all of whom had moderate or severe malnutrition risk. Less than one-third of patients met the guidelines for dietary intake of energy or protein, and this did not differ across malnutrition risk groups. Discussion: Elevated malnutrition risk is a frequent finding in HD patients treated in hospital settings in Israel. Dietary intake does not meet guidelines but does not differ across malnutrition risk categories. Nutrition supplements are underused in HD patients with high malnutrition risk. There is a need to expand the survey to community HD centers.

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“…The practice guidelines and criteria for evaluating the nutritional status in ESRD patients recommend the coordinated use of biochemical measures, body mass, muscle mass, dietary intake, and an integrative nutritional scoring [9,10]. However, it is unclear which method is better to evaluate PEW in ESRD patients on maintenance hemodialysis [11,12]. …”

Section: Introductionmentioning

confidence: 99%

“…Therefore, inadequate intake of protein and energy could be a major determinant in the development of malnutrition [14,16,22,23]. However, the impact of dietary intake or comorbidities on mortality has not been evaluated in ESRD patients on maintenance hemodialysis [12,24,25,26]. …”

Section: Introductionmentioning

confidence: 99%

Nutritional Status Predicts 10-Year Mortality in Patients with End-Stage Renal Disease on Hemodialysis

2017

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Protein-energy wasting (PEW) is associated with mortality in patients with end-stage renal disease (ESRD) on maintenance hemodialysis. The correct diagnosis of PEW is extremely important in order to predict clinical outcomes. However, it is unclear which parameters should be used to diagnose PEW. Therefore, this retrospective observational study investigated the relationship between mortality and nutritional parameters in ESRD patients on maintenance hemodialysis. A total of 144 patients were enrolled. Nutritional parameters, including body mass index, serum albumin, dietary intake, normalized protein catabolic rate (nPCR), and malnutrition inflammation score (MIS), were measured at baseline. Fifty-three patients died during the study. Survivors had significantly higher nPCR (1.10 ± 0.24 g/kg/day vs. 1.01 ± 0.21 g/kg/day; p = 0.048), energy intake (26.7 ± 5.8 kcal/kg vs. 24.3 ± 4.2 kcal/kg; p = 0.009) and protein intake (0.91 ± 0.21 g/kg vs. 0.82 ± 0.24 g/kg; p = 0.020), and lower MIS (5.2 ± 2.3 vs. 6.1 ± 2.1, p = 0.039). In multivariable analysis, energy intake <25 kcal/kg (HR 1.860, 95% CI 1.018–3.399; p = 0.044) and MIS > 5 (HR 2.146, 95% CI 1.173–3.928; p = 0.013) were independent variables associated with all-cause mortality. These results suggest that higher MIS and lower energy intake are harmful to ESRD patients on maintenance hemodialysis. Optimal energy intake could reduce mortality in these patients.

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A Comparison of 8 Nutrition-Related Tests to Predict Mortality in Hemodialysis Patients

Cited by 56 publications

References 45 publications

Association of Geriatric Nutritional Risk Index with Mortality in Hemodialysis Patients: A Meta-Analysis of Cohort Studies

Association of Geriatric Nutritional Risk Index with Mortality in Hemodialysis Patients: A Meta-Analysis of Cohort Studies

Malnutrition Risk in Hemodialysis Patients in Israel: Results of the Status of Nutrition In Hemodialysis Patients Survey Study

Nutritional Status Predicts 10-Year Mortality in Patients with End-Stage Renal Disease on Hemodialysis

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