Comparison of three nutritional screening tools for detecting sarcopenia in patients with maintenance hemodialysis

Abstract

BackgroundMalnutrition, dynapenia, and sarcopenia are prevalent conditions among patients with maintenance hemodialysis (MHD). They are related to numerous adverse health outcomes. The aim of this study was to compare the effect of three nutritional screening tools on predicting the risk of dynapenia and sarcopenia in patients with MHD.MethodsFrom July 2020 to April 2021, a total of 849 patients with MHD were enrolled at seven different healthcare facilities in Shanghai, China in this multi-center cross-sectional study. Geriatric nutritional risk index (GNRI), malnutrition inflammation score (MIS), and creatinine (Cr) index were used for nutritional assessment. The cutoff values of muscle mass and strength to define dynapenia, pre-sarcopenia, and sarcopenia were based on the consensus by the Asia Working Group of Sarcopenia in 2019.ResultsAmong 849, almost 60% were malnourished with the majority suffering from dynapenia (27.7%), followed by sarcopenia (22.7%), and pre-sarcopenia (6.2%).The area under the receiver–operating characteristic curve for GNRI was 0.722 [95% confidence interval (CI) = 0.684–0.760] and 0.723 (95% CI = 0.663–0.783) in predicting sarcopenia and pre-sarcopenia. The GNRI [odds ratio (OR) =6.28, 95% CI: 4.05–9.73], MIS (OR =1.91, 95% CI: 1.31–2.78), and the Cr index (OR =2.73, 95% CI: 1.71–4.34) were all significantly associated with the risk of sarcopenia. More importantly, the sarcopenia predictability of the GNRI appears greater than the MIS and Cr index, while MIS was similar to the Cr index. Similarly, the superiority of GNRI prediction was also found in pre-sarcopenia, but not in dynapenia.ConclusionAll the three nutritional screening tools were significantly associated with an increased risk of sarcopenia. The sarcopenia predictability of the GNRI was greater than the MIS and Cr index.

The role of geriatric nutritional risk index as a predictor for postoperative outcomes in gastrointestinal emergencies

“…Sarcopenia plays an important role as a risk factor for postoperative complications and mortality in several surgeries, 29,30 and is associated with low albumin levels and BMI, 31,32 resulting a low GNRI score. Previous studies have shown that a low GNRI was a predictor of sarcopenia status in patients with type 2 diabetes mellitus and maintenance hemodialysis 33,34 . Moreover, with the inflammation or stress of abdominal emergencies, albumin synthesis is blocked favoring acute‐phase protein synthesis 35 .…”

“…Previous studies have shown that a low GNRI was a predictor of sarcopenia status in patients with type 2 diabetes mellitus and maintenance hemodialysis. 33,34 Moreover, with the inflammation or stress of abdominal emergencies, albumin synthesis is blocked favoring acute-phase protein synthesis. 35 Therefore, the GNRI may provide surgeons with comprehensive information including nutritional, inflammatory, and sarcopenia statuses in abdominal emergencies.…”

The geriatric nutrition risk index is longitudinally associated with incident Sarcopenia: evidence from a 5-year prospective cohort

“…Consideration of LPP in our study may thus reduce the likelihood of misclassifying some sarcopenic patients as normal, thus strengthening validity of results. Besides, associations between GNRI and sarcopenia in many previous studies were established in specific populations, including patients with cirrhosis [ 14 ], type 2 diabetes mellitus (T2DM) [ 16 – 18 ], maintenance hemodialysis [ 19 ] and malignancies [ 20 – 22 ], which may limit generalizability of the findings. Although emphasis should be attached to sarcopenia in these special populations considering its prognostic implications for the diseases [ 43 – 46 ], its early identification also deserves attention in community-dwelling older adults, since it is predictive for mortality in this population [ 47 , 48 ], which may show more significance from a public health perspective.…”

Association of Geriatric Nutritional Risk Index with short-term mortality in patients with severe acute kidney injury: a retrospective cohort study

“…It is worth mentioning that the prevalence of sarcopenia is high in this group [ 17 ]. Therefore, using GNRI, a surrogate indicator for muscle strength [ 33 , 34 ], can effectively solve this limitation. In addition, it is well known that elderly patients have poor nutritional status and are prone to develop sarcopenia [ 35 ], this explains, in part, why the impact of GNRI on death among patients over 65 years of age is more pronounced in the present study.…”