Comparison of creatinine index and geriatric nutritional risk index for nutritional evaluation of patients with hemodialysis

Hwang, Wonsun; Cho, Mi Sook; Oh, Ji Eun; Lee, Ji Hyun; Jeong, Jong Cheol; Shin, Gyu Tae; Kim, Heung Soo; Park, Inwhee

doi:10.1111/hdi.12674

Cited by 18 publications

(19 citation statements)

References 27 publications

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“…The GNRI is correlated with the Malnutrition-Inflammation Score, which is now regarded as the gold standard for diagnosing PEW or malnutrition [22]. The modified Cr index is a marker of skeletal muscle mass and is also correlated with GNRI [23]. In the present study, our mPEW-S was significantly associated with both indexes.…”

Section: Discussionsupporting

confidence: 57%

Association between modified simple protein-energy wasting (PEW) score and all-cause mortality in patients receiving maintenance hemodialysis

et al. 2020

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Background: Protein-energy wasting (PEW) is a frequently observed complication that leads to increased mortality in hemodialysis patients. However, a multifaceted assessment of PEW by combined objective nutritional parameters has not yet been established. Methods: In total, 144 Japanese patients receiving maintenance hemodialysis at a hemodialysis center were retrospectively followed for 7 years. The primary outcome was all-cause death. The main exposure was a modified simple PEW score (0, 1, 2, 3, or 4), calculated from four parameters: serum albumin and creatinine levels, normalized protein catabolic rate, and body mass index. These parameters are included in the subcategories of PEW as defined by the International Society of Renal Nutrition and Management. The cutoff values of the modified simple PEW score components were based on the receiver operating characteristics curves determined by univariate logistic regression analyses. Risk estimates for all-cause mortality were calculated by the Cox proportional hazards model adjusted for potential confounding factors. Results: During the median 5.7-years follow-up period, 37 patients died of any cause. When patients were divided into three subgroups (G1-G3) based on the modified simple PEW score, a multivariable-adjusted analysis showed that the risks of all-cause death in groups G2 and G3 were significantly higher than in the lowest score group (G1), with hazard risk (95% confidence interval) 3.10 (1.16-8.26) (P = 0.024) and 5.68 (1.85-17.45) (P = 0.002), respectively. Conclusions: The modified simple PEW score is a useful composite indicator of nutritional status that stratifies the risk of all-cause mortality in patients undergoing maintenance hemodialysis.

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Section: Discussionsupporting

confidence: 57%

Association between modified simple protein-energy wasting (PEW) score and all-cause mortality in patients receiving maintenance hemodialysis

et al. 2020

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“…Although the GNRI and Cr index are calculated using a different set of clinical parameters, our results suggest that they partially share nutritional information regarding the predictability of all-cause mortality. One very recent study compared the model predictability of the GNRI and Cr index regarding all-cause mortality in a relatively small cohort of 88 Chinese hemodialysis patients 21 . Results showed that model performance for all-cause mortality with the Cr index was better than that with the GNRI.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent study infection-related and all-cause death predicted by the GNRI and by serum Cr were comparable, indicating that serum albumin-based surrogates and serum Cr-based surrogates are equally useful for the prediction of mortality in hemodialysis patients 24 . Both GNRI and Cr index are found to be valid tools for longitudinal observation of nutritional status in patients receiving maintenance hemodialysis 21,25 . Given that outcome predictability and nutritional information derived from the GNRI and the Cr index are comparable, the GNRI-a simpler form of nutritional surrogate-may be more useful and practical for clinical use than the Cr index in patients undergoing maintenance hemodialysis.…”

Section: Adjusted Odds Ratio (95% Ci) For a Low Cr Index Category P-vmentioning

confidence: 99%

“…If outcome predictability is comparable between these two indexes, the simpler of the two would be more practical and useful in the clinical setting. Despite these, few studies have compared the usefulness and predictive ability of these two nutritional indexes regarding all-cause and cardiovascular mortality in this population 21 . It is clinically important to directly compare these two indexes in the same study population comprising a relatively large number of hemodialysis patients.…”

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confidence: 99%

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Geriatric Nutritional Risk Index (GNRI) and Creatinine Index Equally Predict the Risk of Mortality in Hemodialysis Patients: J-DOPPS

Yamada

Yamamoto

Fukuma

et al. 2020

Sci Rep

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the geriatric nutritional risk index (GnRi) and creatinine (cr) index are indexes often used as nutritional surrogates in patients receiving hemodialysis. However, few studies have directly compared the clinical characteristics of these two indexes. We investigated 3,536 hemodialysis patients enrolled in the Japan DOPPS phases 4 and 5. The primary outcome was all-cause mortality and the main exposures were the GNRI and Cr index. We confirmed and compared the association between these indexes and mortality risk as estimated by a multivariable-adjusted cox proportional hazards model. During the median 2.2-year follow-up period, 414 patients died of any cause. In the multivariable-adjusted model, lower GnRi and cr index were both associated with increased risk of all-cause mortality, and these associations were further confirmed by restricted cubic spline curves. The predictability of all-cause mortality, as represented by the c-statistic, was comparable between the two indexes. furthermore, baseline nutritional surrogates that corresponded with lower GnRi or cr index values were comparable between the two indexes. Given that calculating the GnRi is simpler than calculating the cr index, our data suggest that the GnRi may be preferable to the cr index for predicting clinical outcomes in patients undergoing maintenance hemodialysis.Malnutrition is highly prevalent in patients receiving maintenance hemodialysis 1-3 . Inflammation often coexists with malnutrition. Because these two pathologies synergistically promote clinically important complications, including atherosclerotic diseases, they are now jointly recognized by the integrated term "malnutrition-inflammation-atherosclerosis (MIA) syndrome" or "malnutrition-inflammation complex/cachexia syndrome (MICS)" 4,5 . Identification of objective markers that both reflect MIA syndrome and can be used for daily evaluation of nutritional and inflammatory status in this population is now urgently required.A wide variety of nutritional and inflammatory markers and tools have been reported for the evaluation of MIA syndrome or MICS in hemodialysis patients. Because these markers and indexes are insufficient when used alone, many clinicians use them in combination in clinical practice. These include subjective global assessment (SGA); malnutrition-inflammation score (MIS); serum levels of albumin, creatinine (Cr), and C-reactive protein (CRP); body mass index (BMI); normalized protein catabolic rate (nPCR); interleukin-6; geriatric nutritional risk index (GNRI); Cr index; Objective Score of Nutrition on Dialysis (OSND); simple protein energy wasting score; Subjective Global Assessment-Dialysis Malnutrition Score (SGA-DMS); bioelectrical impedance analysis (BIA); and dual energy X-ray absorptiometry (DEXA) 3,5-15 . Of these, the GNRI and Cr index are often used to evaluate nutritional status in hemodialysis patients 9,10 . The GNRI is calculated by serum albumin level and BMI, while the Cr index is determined by age, gender, Kt/V for urea, and pre-dialysis serum Cr level. Thes...

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“…The problem of poor nutritional status of patients with CKD is even considered as the leading cause of poor clinical outcomes and quality of life and mortality [6,7]. Several studies assessing the nutritional status of patients with CKD, using methods such as anthropometric assessments and biochemical evaluation, have shown a positive correlation with mortality [17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Assessment of nutritional status, dietary intake and adherence to dietary recommendations in hemodialysis patients

Moustakim¹,

Mbarki²,

Mohammed³

et al. 2020

GSC Adv. Res. Rev.

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Assessing dietary habits and nutritional status in patients with end stage kidney disease (ESKD) treated with maintenance hemodialysis (HD) plays a crucial role in the prevention of protein energy malnutrition. The aim of this study was, on one hand, to assess nutritional status and dietary intake of HD patients in comparison with the guidelines recommendations and, on the other hand, to determine the characteristics of those who didn't meet their nutritional needs. In a sample of 156 HD patients (70 women and 86 men), clinical data, anthropometric measurements and two 24 hour dietary recalls were collected to evaluate the nutritional status and dietary intake. The results showed that based on the Body Mass Index (BMI), appropriate nutritional status was reported for only 60.6% of the patients. The mean energy intake was 1904.98 ±592.50 kcal per day, only 16.8% of participants were found compliant regarding the recommended intake of energy density; about 33 % met the recommended minimum of 1.2g/kg of protein per day and only 36.5% have adequate fiber consumption. The protein and energy density were negatively correlated with age, BMI and waist circumference. No patients achieved the recommendations concerning the saturated fat intake. In conclusion, the study data report that a high proportion of dialysis patients did not meet current renal specific dietary requirements and that the diet quality is considered poor. These results call the attention to individual dietetic counseling and promotion of a global dietary approach in hemodialysis patients in order to improve clinical outcomes and the quality of life of chronic kidney patients.

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Comparison of creatinine index and geriatric nutritional risk index for nutritional evaluation of patients with hemodialysis

Cited by 18 publications

References 27 publications

Association between modified simple protein-energy wasting (PEW) score and all-cause mortality in patients receiving maintenance hemodialysis

Association between modified simple protein-energy wasting (PEW) score and all-cause mortality in patients receiving maintenance hemodialysis

Geriatric Nutritional Risk Index (GNRI) and Creatinine Index Equally Predict the Risk of Mortality in Hemodialysis Patients: J-DOPPS

Assessment of nutritional status, dietary intake and adherence to dietary recommendations in hemodialysis patients

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