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

TLDR

Malnutrition is common among haemodialysis patients, and the Geriatric Nutritional Risk Index (GNRI) has emerged as a simple, accurate tool to assess their nutritional status. The study aimed to evaluate whether GNRI predicts mortality in chronic haemodialysis patients. A prospective cohort of 490 maintenance haemodialysis patients (mean age 60 ± 12 years) was followed for 60 months, with Kaplan–Meier and Cox proportional hazards analyses used to assess mortality predictors. During the 60‑month follow‑up, 129 deaths occurred; patients with GNRI < 90 had significantly lower survival, and GNRI was an independent mortality predictor (HR 0.962, 95 % CI 0.931–0.995), establishing a 90‑point cutoff as clinically useful.

Abstract

Malnutrition is a common complication in haemodialysis patients. Recently, the Geriatric Nutritional Risk Index (GNRI) has been reported as a simple and accurate tool to assess nutritional status of haemodialysis patients. Our objective was to examine the association between GNRI and mortality in chronic haemodialysis patients.We examined the GNRI of 490 maintenance haemodialysis patients (60 ± 12 years, 293 males and 197 females) and followed up these patients for 60 months. Predictors for all-cause death were examined using Kaplan-Meier analysis and Cox proportional analyses.The GNRI was 98.0 ± 6.0, and was significantly and negatively correlated with age and haemodialysis duration. During the 60-month follow-up period, 129 patients died. According to the highest positive likelihood and risk ratios, the cutoff value of GNRI for mortality was set at 90. Kaplan-Meier analysis revealed that patients with a GNRI <90 (n = 50) had a significantly lower survival rate, compared to those with GNRI ≥90 (n = 440) (log-rank test, P < 0.0001). Multivariate Cox proportional hazards analyses demonstrated that GNRI was a significant predictor for mortality [hazard ratio (HR) 0.962, 95% confidence interval (CI) 0.931-0.995, P < 0.05], after adjustment for age, gender, C-reactive protein, presence of diabetes and haemodialysis duration.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.