Department of Internal Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Obama, Japan.
Critical Care Center, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan.
Geriatr Gerontol Int. 2018 Nov;18(11):1556-1561. doi: 10.1111/ggi.13524. Epub 2018 Oct 11.
The target Geriatric Nutritional Risk Index (GNRI) for patients on chronic maintenance hemodialysis is unclear. We aimed to determine the relationship between the GNRI and independent walking ability in such patients.
In the present retrospective cohort study, 90 patients receiving chronic maintenance hemodialysis were included. Logistic regression analyses were carried out to evaluate the relationship between the GNRI and independent walking ability. Receiver operating characteristic curve analysis was carried out to determine the cut-off GNRI for predicting independent walking ability.
Multivariate logistic regression analysis showed significant differences in age (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.6-0.9), creatinine generation rate percentage (OR 1.1, 95% CI 1.0-1.2), GNRI (OR 1.4, 95% CI 1.1-1.8; P < 0.01) and urea removal rate (OR 0.3, 95% CI 0.1-0.9; P < 0.05). The cut-off GNRI for independent walking ability was 86.7 (area under the curve 0.80, sensitivity 92.1%, specificity 66.7%, positive hit ratio 86.6%, negative hit ratio 78.3%). The factors correlated with survival in the univariate analysis were the GNRI, equilibrated Kt/V, urea removal rate, clear space rate, salt intake amount (P < 0.01), number of days of hospitalization and %creatinine generation rate (P < 0.05). The Cox proportional hazard regression model showed an OR of 0.77 (95% CI 0.32-1.8) at a GNRI <86/GNRI ≥86. In the multivariate survival analysis, we observed no significant differences in any of the factors.
GNRI was correlated with walking ability, which indicated that GNRI might predict future walking ability; also, a GNRI of 87 might be the target for maintaining walking ability. Geriatr Gerontol Int 2018; 18: 1556-1561.
慢性维持性血液透析患者的老年营养风险指数（GNRI）目标尚不清楚。本研究旨在探讨 GNRI 与此类患者独立行走能力之间的关系。
本回顾性队列研究纳入了 90 名接受慢性维持性血液透析的患者。进行 logistic 回归分析以评估 GNRI 与独立行走能力之间的关系。进行受试者工作特征曲线分析以确定预测独立行走能力的 GNRI 截断值。
多变量 logistic 回归分析显示，年龄（比值比 [OR] 0.8，95%置信区间 [CI] 0.6-0.9）、肌酐生成率百分比（OR 1.1，95%CI 1.0-1.2）、GNRI（OR 1.4，95%CI 1.1-1.8；P<0.01）和尿素清除率（OR 0.3，95%CI 0.1-0.9；P<0.05）存在显著差异。独立行走能力的 GNRI 截断值为 86.7（曲线下面积 0.80，敏感性 92.1%，特异性 66.7%，阳性预测值 86.6%，阴性预测值 78.3%）。单因素分析中与生存相关的因素包括 GNRI、平衡 Kt/V、尿素清除率、清空间率、盐摄入量（P<0.01）、住院天数和%肌酐生成率（P<0.05）。Cox 比例风险回归模型显示 GNRI<86/GNRI≥86 的 OR 为 0.77（95%CI 0.32-1.8）。在多因素生存分析中，各因素之间无显著差异。
GNRI 与行走能力相关，表明 GNRI 可能预测未来的行走能力；此外，GNRI 为 87 可能是维持行走能力的目标。
