Panichi Vincenzo, Cupisti Adamasco, Rosati Alberto, Di Giorgio Adriana, Scatena Alessia, Menconi Ophelia, Bozzoli Laura, Bottai Anna
Nephrology and Dialysis Unit, Versilia Hospital, Lido di Camaiore, Italy,
J Nephrol. 2014 Apr;27(2):193-201. doi: 10.1007/s40620-013-0033-0. Epub 2014 Jan 16.
Malnutrition is a common complication in hemodialysis (HD) patients and it is related to morbidity and mortality. Although a gold standard method for diagnosis of malnutrition is not available, serum albumin, body weight and height are commonly used and are included in the calculation of the Geriatric nutritional risk index (GNRI). Recently the association between GNRI and mortality in chronic HD patients has been documented in Asian populations. Our aim was to examine the relative reliability of the GNRI as a mortality and morbidity predictor in an Italian HD cohort.
We prospectively examined the GNRI of 753 maintenance HD patients aged 65.7 ± 14.1 years, 457 males, included in the Riscavid cohort, and followed them up for 84 months. Predictors for all-cause death were examined using Kaplan-Meier and Cox proportional-hazards analyses.
Low GNRI was significantly associated with signs of wasting, i.e. low Body mass index, hypoalbuminemia, low normalized protein catabolic rate. Patients within the lowest GNRI quartile had a significantly lower survival rate than those in the 2nd to 4th quartile (p < 0.001). Multivariate Cox proportional-hazards analysis demonstrated that the lowest quartile of GNRI was a significant predictor of case mix adjusted all-cause mortality (HR 1.72; CI 1.35-2.18, p < 0.001).
These results demonstrate that low GNRI (<92) is associated with malnutrition and is a strong predictor of overall mortality in HD patients. However, cardiovascular events did not differ among the GNRI quartiles. A low GNRI score can be considered a simple and reliable marker of malnutrition and predictor for mortality risk in Caucasian HD patients.
营养不良是血液透析（HD）患者常见的并发症，与发病率和死亡率相关。尽管尚无诊断营养不良的金标准方法，但血清白蛋白、体重和身高是常用指标，并被纳入老年营养风险指数（GNRI）的计算中。最近，亚洲人群中已记录了GNRI与慢性HD患者死亡率之间的关联。我们的目的是在意大利HD队列中检验GNRI作为死亡率和发病率预测指标的相对可靠性。
我们前瞻性地研究了纳入Riscavid队列的753例维持性HD患者的GNRI，这些患者年龄为65.7±14.1岁，男性457例，并对他们进行了84个月的随访。使用Kaplan-Meier和Cox比例风险分析检查全因死亡的预测因素。
低GNRI与消瘦体征显著相关，即低体重指数、低白蛋白血症、低标准化蛋白分解率。GNRI最低四分位数组的患者生存率明显低于第二至第四四分位数组的患者（p<0.001）。多变量Cox比例风险分析表明，GNRI最低四分位数是病例组合调整后的全因死亡率的显著预测因素（HR 1.72；CI 1.35-2.18，p<0.001）。
这些结果表明，低GNRI（<92）与营养不良相关，是HD患者总体死亡率的强预测因素。然而，GNRI各四分位数组之间的心血管事件并无差异。低GNRI评分可被视为白种人HD患者营养不良的简单可靠标志物和死亡风险预测指标。
