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

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

doi:10.1093/ndt/gfq211

Cited by 161 publications

(168 citation statements)

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“…GNRI, geriatric nutritional risk index; DEI, daily energy intake; DPI, daily protein intake; nPNA, normalized protein nitrogen appearance; TLC, total lymphocyte count; EPO, erythropoietin; TSF, triceps skinfold thickness; MAC, mid-arm circumference; MAMC, mid-arm muscle circumference calculated; TBW, total body water; ECW, extracellular water; ECW/TBW, extracellular water/total body water ratio; FM, fat mass; FFM, fat free mass. GNRI (6,11) in hemodialysis patients. Given the estimates of the regression coefficients in Tables 3 and 4, it appears that changes of these scores over time were associated with corresponding changes over time in markers of dietary intake (examined by both dietary recall and nPNA calculation), laboratory markers of nutrition and body composition parameters in the case of MIS (Table 3), and only with laboratory and body composition parameters in the case of GNRI (Table 4).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, GNRI ,90 was demonstrated as an indicator of poor nutritional status and as a significant predictor of mortality in 490 Japanese chronic hemodialysis patients (11).…”

Section: Gnrimentioning

confidence: 99%

“…Still, MIS is based on the SGA and therefore requires a subjective assessment. There are, however, some simple fully objective nutritional screening scores that can be used in hemodialysis patients for nutritional risk assessment (6,(11)(12)(13). Of the objective nutritional assessments, the geriatric nutritional risk index (GNRI) is recommended as the simplest and most accurate risk index.…”

Section: Introductionmentioning

confidence: 99%

“…Of the objective nutritional assessments, the geriatric nutritional risk index (GNRI) is recommended as the simplest and most accurate risk index. It was compared with the MIS (6) and was validated as a significant predictor of mortality in a study on Japanese chronic hemodialysis patients (11).…”

Section: Introductionmentioning

confidence: 99%

“…Reports were published on the reliability and concurrent validity for the cross-sectional assessment of the nutritional status of hemodialysis patients by both MIS (7)(8)(9) and GNRI (6,11). To the best of our knowledge, no longitudinal performance of most of the nutritional scores was investigated in hemodialysis patients.…”

Section: Introductionmentioning

confidence: 99%

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Comparison Analysis of Nutritional Scores for Serial Monitoring of Nutritional Status in Hemodialysis Patients

Beberashvili

Azar

Sinuani

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives This study aimed to compare the longitudinal performance of the malnutritioninflammation score (MIS) and the geriatric nutritional risk index (GNRI), two nutritional scores for patients on maintenance hemodialysis.Design, setting, participants, & measurements Nutritional scores, dietary intake, biochemical markers, and body composition analysis were performed at baseline and at 6, 12, and 18 months after enrollment (which took place from January through December 2006) on 75 prevalent hemodialysis patients (43% women, mean age 64.8611.9 years). The patients underwent simultaneous MIS and GNRI assessments calculated by two independent examiners from baseline. The study period was 46.8616.4 months.Results GNRI had higher interobserver agreement (weighted k-score 0.98) than MIS (weighted k-score 0.62). Longitudinally, a 1-unit increase in MIS was associated with a 0.41 kcal/kg per day reduction in daily energy intake (P,0.001) and with a 0.014 g/kg per day reduction in nPNA (P=0.02). GNRI did not correlate with the change over time of dietary intake. Longitudinal changes of both scores were associated with appropriate changes over time in levels of nutritional biomarkers, inflammation (IL-6), and body composition parameters. Both scores expressed significant associations with prospective hospitalization, whereas only MIS was associated with mortality in this cohort. The multivariate Cox proportional hazard ratio was 1.15 for death for each 1-unit increase in the MIS (95% confidence interval, 1.03-1.3; P=0.02).Conclusions Both MIS and GNRI are valid tools for longitudinal assessment of hemodialysis patients' nutritional status. MIS has lower interobserver reproducibility than GNRI; however, MIS is more comprehensive than GNRI.

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Section: Discussionmentioning

confidence: 99%

“…Recently, GNRI ,90 was demonstrated as an indicator of poor nutritional status and as a significant predictor of mortality in 490 Japanese chronic hemodialysis patients (11).…”

Section: Gnrimentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Comparison Analysis of Nutritional Scores for Serial Monitoring of Nutritional Status in Hemodialysis Patients

Beberashvili

Azar

Sinuani

et al. 2013

Clinical Journal of the American Society of Nephrology

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Association of impedance ratio with corrected Geriatric Nutritional Risk Index in older patients with nondialysis chronic kidney disease stage 5

Han

Lee³

2021

J Parenter Enteral Nutr

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Background The usual calculation of body mass index (BMI) can be misleading in patients with advanced chronic kidney disease (CKD) because their altered fluid balances may not be reflected. We obtained corrected BMI (cBMI) and corrected Geriatric Nutritional Risk Index (cGNRI) values and investigated whether the impedance ratio (IR) of 200/5 kHz, measured using bioimpedance spectroscopy, was associated with cGNRI in older patients with nondialysis CKD stage 5 (CKD5‐ND). Methods Patients over 65 years old (n = 118) were divided into groups by cGNRI tertiles. The differences between the correlations were tested using Steiger's z‐test. The IR and cBMI were used as both continuous and categorical variables in the regression analyses to determine the factors that were independently associated with the cGNRI. Results Patients in the third cGNRI tertile had a significantly lower mean IR than those in the other 2 tertiles (P < .001). Across the 3 cGNRI tertile groups, the IR was incrementally lower in the higher cGNRI tertiles (P for trend < .001). The Steiger's z‐test showed that the IR had a significantly stronger correlation with cGNRI than cBMI had with cGNRI. In the multivariable linear regression analyses, the IR was independently associated with the cGNRI, after adjusting for various confounders. Conclusion The current results revealed that the IR was a more sensitive indicator of nutrition risk than BMI and was independently associated with cGNRI in older patients with CKD5‐ND. Our study suggests that the IR is an appropriate tool for nutrition risk screening.

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Protein Energy Wasting in Chronic Kidney Disease

Kanda

2020

Recent Advances of Sarcopenia and Frailty in CKD

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

Abstract: 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.

Cited by 161 publications

References 19 publications

Comparison Analysis of Nutritional Scores for Serial Monitoring of Nutritional Status in Hemodialysis Patients

Comparison Analysis of Nutritional Scores for Serial Monitoring of Nutritional Status in Hemodialysis Patients

Association of impedance ratio with corrected Geriatric Nutritional Risk Index in older patients with nondialysis chronic kidney disease stage 5

Protein Energy Wasting in Chronic Kidney Disease

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