Modified Creatinine Index and Clinical Outcomes of Hemodialysis Patients: An Indicator of Sarcopenia?

Yamamoto, Shohei; Matsuzawa, Ryota; Hoshi, Keika; Suzuki, Yuta; Harada, Manae; Watanabe, Tetsu; Isobe, Yusuke; Imamura, Keigo; Osada, Shiwori; Yoshida, Atsushi; Kamiya, Kentaro; Matsunaga, Atsuhiko

doi:10.1053/j.jrn.2020.08.006

Cited by 20 publications

(20 citation statements)

References 35 publications

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“…However, Chen et al recently conducted a large cohort study and reported that the predictability of all-cause and cardiovascular mortality of GNRI was comparable to that of MIS [26]. The mCI is an indicator of muscle wastage and an objective nutritional assessment tool used in HD patients [7,27,28]. Hwang et al reported that the mCI was correlated with the GNRI [12], and Tsai et al recently found that the mCI is an independent predictor of PEW [29].…”

Section: Discussionmentioning

confidence: 99%

Combined Evaluation of Geriatric Nutritional Risk Index and Modified Creatinine Index for Predicting Mortality in Patients on Hemodialysis

Yajima

Arao

2022

Nutrients

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The geriatric nutritional risk index (GNRI) and modified creatinine index (mCI) are surrogate markers of protein-energy wasting in patients receiving hemodialysis. We aimed to examine whether a combined evaluation of these indices improved mortality prediction in this population. We retrospectively investigated 263 hemodialysis patients divided into two groups, using 91.2 and 20.16 mg/kg/day as cut-off values of GNRI and mCI, respectively. The resultant four groups were reshuffled into four subgroups defined using combinations of cut-off values of both indices and were followed up. During the follow-up period (median: 3.1 years), 103 patients died (46/103, cardiovascular causes). Lower GNRI and lower mCI were independently associated with all-cause mortality (adjusted hazard ratio (aHR) 4.96, 95% confidence intervals (CI) 3.10–7.94, and aHR 1.92, 95% CI 1.22–3.02, respectively). The aHR value for the lower GNRI and lower mCI group vs. the higher GNRI and higher mCI group was 7.95 (95% CI 4.38–14.43). Further, the addition of GNRI and mCI to the baseline risk assessment model significantly improved the C-index of all-cause mortality (0.801 to 0.835, p = 0.025). The simultaneous evaluation of GNRI and mCI could be clinically useful to stratify the risk of mortality and to improve the predictability of mortality in patients on hemodialysis.

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Section: Discussionmentioning

confidence: 99%

Combined Evaluation of Geriatric Nutritional Risk Index and Modified Creatinine Index for Predicting Mortality in Patients on Hemodialysis

Yajima

Arao

2022

Nutrients

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“…In contrast, in our work, increased creatinine concentration (as another renal function marker) was not associated with Ni concentration, while other studies reported significant and direct Ni concentration correlations both in blood [ 63 ] and urine [ 71 ]. One possible explanation for this apparent discrepancy could be due to the fact that most creatinine present in blood is derived from the skeletal muscle amino acids, which may be reduced in older individuals because sarcopenia can lower creatinine values [ 72 , 73 , 74 ] and thereby mask renal function impairment [ 75 ]. In fact, creatinine levels have been shown to be higher in 70-year-old participants than in a comparison population [ 76 ], and the blood creatinine level is not a good marker for renal function in older individuals [ 77 ].…”

Section: Discussionmentioning

confidence: 99%

Plasma Nickel Levels Correlate with Low Muscular Strength and Renal Function Parameters in Patients with Prostate Cancer

et al. 2022

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Nickel is associated with cancer in occupational exposure. However, few studies have been devoted to analyzing the effects of nickel at environmental concentrations in cancer patients. In this work, the concentration of nickel in blood samples from patients with prostate cancer (PCa) was evaluated because this metal displays androgenic and estrogenic effects that play a crucial role in prostate carcinogenesis and treatment. We, therefore, compared blood nickel concentration in patients with PCa (non-occupationally exposed) (n = 46) with those in control age-matched individuals (n = 46). We also analyzed if there was any association between sociodemographic factors, clinical variables, geriatric evaluation assessment results, blood cell counts, or biochemical, androgen and estrogen concentrations. Using inductively coupled plasma-mass spectroscopy on the plasma samples, we observed a mean nickel level of 4.97 ± 1.20 µg/L in the PCa group and 3.59 ± 0.49 µg/L in the control group, with a non-significant effect (p = 0.293) between the two groups. The nickel concentration was significantly correlated with patient age (p = 0.005) and reduced handgrip strength (p = 0.003). Regarding biochemical parameters, significant associations were found with the renal glomerular filtration rate (p = 0.024) and blood urea levels (p = 0.016). No significant correlations were observed with other blood analytical parameters or testosterone or estradiol levels. These specific renal function and muscle strength effects were observed at environmental nickel exposure levels believed to be safe or at least far from the high concentrations observed after occupational exposure. Therefore, these parameters deserve further study, given that they could help pinpoint further public health concerns regarding nickel exposure in the general population.

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“…Yamamoto et al tested whether the modified creatinine index could predict mortality and cardiovascular hospitalization independently or additively to measures of muscle function. 24 The authors found that the modified creatinine index performed as well as handgrip strength and gait speed predicting mortality in dialysis patients. Furthermore, when the modified creatinine index was added to the regression model with handgrip strength and gait speed, it enhanced the prognostic utility.…”

Section: Creatinine Is a Muscle Markermentioning

confidence: 98%

“…Among the studies examining this phenomenon by Parker et al, who showed that serum creatinine levels below 8.0 mg/ dL in hemodialysis patients predicted higher mortality, whereas those above 10 mg/dL were associated with greater survival. 23 Extending the observation that serum creatinine is related to muscle mass and clinical outcomes is a study by Yamamoto et al 24 Their investigation was premised on supposing that muscle function tests better predict morbidity and mortality in ESKD patients than muscle mass. Canaud et al developed the creatinine (Cr) index from kinetic modeling of creatinine with hemodialysis, successfully demonstrating that higher creatinine values were associated with more significant skeletal muscle in hemodialysis patients' mass.…”

Section: Creatinine Is a Muscle Markermentioning

confidence: 99%

Progress in the Identification and Management of Protein-Energy Wasting and Sarcopenia in Chronic Kidney Disease

Workeneh

Kalantar-Zadeh

Moore

2021

Journal of Renal Nutrition

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Modified Creatinine Index and Clinical Outcomes of Hemodialysis Patients: An Indicator of Sarcopenia?

Cited by 20 publications

References 35 publications

Combined Evaluation of Geriatric Nutritional Risk Index and Modified Creatinine Index for Predicting Mortality in Patients on Hemodialysis

Combined Evaluation of Geriatric Nutritional Risk Index and Modified Creatinine Index for Predicting Mortality in Patients on Hemodialysis

Plasma Nickel Levels Correlate with Low Muscular Strength and Renal Function Parameters in Patients with Prostate Cancer

Progress in the Identification and Management of Protein-Energy Wasting and Sarcopenia in Chronic Kidney Disease

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