Evaluation of nutritional status and prognostic impact assessed by the prognostic nutritional index in children with chronic kidney disease

Abstract

To evaluate the nutritional status of children with chronic kidney disease (CKD) before dialysis via a series of indexes, and investigate the prognostic impact of nutritional status in these patients assessed by the Prognostic Nutritional Index (PNI). Fifty-four children with CKD before dialysis were enrolled in this study. The nutritional status was evaluated by different indexes, including dietary intake, anthropometry data and biochemical parameters. Additionally, PNI is calculated as 10 × serum albumin (g/dL) + 0.005 × lymphocyte count (/mm 3 ). Glomerular filtration rate (GFR) of patients with different PNI scores was followed up. Thirty-four patients (63.0%) experienced unreasonable dietary intake, and the patients with CKD stage 4 were characterized by lower energy intake. The height was the most affected anthropometry parameter. Additionally, 46 patients (85.2%) suffered from anemia. The serum albumin of 42 patients (77.8%) was <35 g/L, while 34 cases (63.0%) had increased cholesterol and triglyceride. According to the PNI scores, the patients were divided into 3 groups: high-PNI (PNI ≥ 38), middle-PNI (35 ≤ PNI < 38), and low-PNI (PNI < 35). Of the 54 patients, the PNI was <35 in 29 (53.7%) and ≥38 in 13 (24.1%). The patients with CKD stage 4 were belonged to the low-PNI group. At follow-up, GFR decreased significantly in patients with low-PNI scores compared with the high-PNI group ( P < .05). Malnutrition, as a common complication of CKD, has a prognostic impact in children with CKD before dialysis, as assessed by the PNI score.

Impact of nutritional index on contrast-associated acute kidney injury and mortality after percutaneous coronary intervention

“…After Onodera suggested the cutoff of PNI value as 45 13 , this is frequently used 17 , 38 . However, the researchers chose several cutoff levels according to study design, such as median, tertile, or ROC analysis 15 , 18 , 20 , 39 . In previous studies, the PNI cut-off value for defining undernutrition varied between 45 and 50.…”

“…The prognostic nutritional index (PNI), calculated from one’s serum albumin concentration and total lymphocyte count in the peripheral blood, was developed by Onodera 13 to determine the nutritional and inflammatory status of surgical patients. PNI is a simple indicator used not only in postoperative outcomes in patients but also in evaluating the nutritional status of patients with malignancies 14 , 15 , pulmonary 16 , 17 , heart 18 , 19 , and kidney diseases 20 . However, the prognostic value of PNI in CA-AKI and patient mortality after PCI have not yet been validated.…”

Prognostic Nutritional Index as a Predictor of 30-Day Mortality Among Patients Admitted to Intensive Care Unit with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Single-Center Retrospective Cohort Study

“…PNI was initially developed to evaluate preoperative nutritional conditions and surgical complications in patients with gastrointestinal cancers [ 6 ]. Recently, it has been described as an accurate and independent prognostic predictor in human cancers [ 7 – 10 ], chronic kidney and heart disease [ 11 , 12 ], and autoimmune disease [ 13 , 14 ].…”

Prognostic nutritional index predicts acute kidney injury and mortality of patients in the coronary care unit

“…Furthermore, patients in the CCU are often in a heightened proinflammatory state, which can significantly worsen nutritional status ( 34 ), and AKI is known to be associated with intrarenal and systemic inflammation ( 35 ). Consequently, PNI, combined serum albumin and total lymphocyte count, which represent nutritional status and chronic inflammation ( 36 , 37 ), may be indicated for risk stratification and clinical management for patients in the CCU. In the present study, it was demonstrated that PNI, which is clinically and easily available, was an independent predictor for the development of AKI and prognosis in patients in the CCU.…”