Geriatric Nutritional Risk Index Is a Non-Inferior Prognostic Marker Compared to Albumin in Hemodialysis Patients: A 5-Year Cohort Study

Jia-Hong Lin ； Horng-Rong Chang ； Jen-Pi Tsai ； Sheng-Wen Wu ； Pao-Yu Tsai ； Jong-Da Lian ； Tung-Wei Hung

《Acta Nephrologica》 34卷1期 (2020/03) Pp. 34-44

https://doi.org/10.6221/AN.202003_34(1).0005

摘要

BACKGROUND: Nutritional status is a powerful predictor of survival in maintenance hemodialysis (HD) patients but remains challenging to access. This study examined whether geriatric nutritional risk index (GNRI) is a better predictor of overall mortality than serum albumin concentration by using the receiver operating characteristic (ROC) curve analysis in 151 patients undergoing maintenance HD for 5 years. METHODS: In December 2007, 151 HD patients were enrolled and followed up for 5 years till December 2012. Patients were divided into alive and expired after 5 years of observation. In the cohort of maintenance HD patients, predictors for all-cause death were age, body mass index, normalized protein catabolic rate (nPCR), GNRI, serum blood urea nitrogen, creatinine, Kt/V (Daugirdes and Gotch), urea reduction ratio, ultrafiltration rate, glucose, triglyceride, cholesterol, uric acid, albumin, sodium, potassium, calcium, phosphorus, calcium-phosphate product, serum parathyroid hormone level, blood hemoglobin level, hematocrit, and white blood cell count. Predictors were examined using Cox proportional and Kaplan-Meier analysis. The predictive performance of the models was described in areas under ROC curves. RESULTS: In the study, HD patients who remained alive showed younger age, fewer percentage of diabetes mellitus (DM), higher percentage of receiving high-flux dialysis mode, higher serum creatinine, albumin, calcium, and higher GNRI score. By univariate Cox proportional hazards regression analysis, age, DM, dialysis mode, serum creatinine, albumin, nPCR, and GNRI were significant markers to predict death. Multivariate analysis showed that albumin (hazard ratio [HR], 0.415; 95% confidence interval [CI], 0.185-0.933; P = 0.034) and GNRI score (HR, 0.951; 95% CI, 0.906-0.999; P = 0.045) were independent factors predicting death of HD patients. The ROC curve analysis showed albumin (area under curve [AUC], 0.653; P = 0.006) and GNRI (AUC, 0.639; P = 0.009) could predict the death of HD patients, and both had a similar capacity (P = 0.354) for predicting survival of HD patients. CONCLUSION: Our results demonstrated calculating GNRI could be a non-inferior prognostic marker than albumin in predicting the death of HD patients.

關鍵字

albumin ； geriatric nutritional risk index ； hemodialysis ； dialysis survival ； dialysis prognostic marker