Impact of Geriatric Nutritional Risk Index and Modified Creatinine Index Combination on Mortality in Hemodialysis Patients

Abstract

The prognostic impact of the combination of a geriatric nutritional risk index (GRNI) and modified creatinine index, both of which assess nutritious status in hemodialysis patients, has not yet been well investigated thus far. Patients receiving maintenance hemodialysis in our institutes between February 2011 and January 2017 were retrospectively included. The baseline GRNI and modified Creatinine index were calculated and the impact of their combination on 5-year all-cause mortality following the index hemodialysis was investigated. A total of 183 patients (68.3 ± 12.4 years, 98 men, hemodialysis duration 97 ± 89 months) were followed from the index hemodialysis for 5.5 years. Mean GNRI was 91.2 and mean modified Creatinine index was 22.2 in men and 19.6 in women. The 5-year survival was significantly stratified by the median values of GNRI and modified Creatinine index (p < 0.05 for both). Patients with low GNRI and a low modified Creatinine index had lower 5-year survival than those with the other three combination patterns (p < 0.05). A combination of GNRI and modified Creatinine index may be a promising tool to risk stratify mortality in dialysis patients.

Synergistic Effects of the Geriatric Nutritional Risk Index and the Modified Creatinine Index for Predicting Mortality in Patients on Hemodialysis

“…Therefore, cardiovascular and infection-related mortality remain to be clarified. Fujioka et al investigated 183 patients on hemodialysis with a mean hemodialysis vintage of 97 months for 5.5 years [15]. The hemodialysis vintage and follow-up in their study are similar to those in our study.…”

“…The high GNRI + low mCI group tended to show a higher mortality rate than that in the low GNRI + high mCI group in our study, which was not observed in the two previous studies mentioned above [14,15]. This discrepancy between studies might have been due to differences in the management of volume control.…”

“…Recently, two studies focused on a combined evaluation of these two indices for evaluating mortality [14,15]. Both of them showed that patients with low GNRI + low mCI scores were strongly associated with a poor outcome.…”

“…Therefore, we set the GNRI cut-off value at 92 to divide the patients into two groups. With regard to the mCI, previous studies divided patients into two groups by the cut-off value of 19-22 mg/kg/day [14,15]. They simply set the cut-off value from their median value of the mCI.…”

“…Interestingly, two recent studies reported clinical usefulness with combined evaluation of the GNRI and the mCI for mortality in hemodialysis patients [14,15]. However, each study only investigated a relatively small sample size at a single center without any consideration for residual kidney function.…”