Department of Nephrology, Matsunami General Hospital, Gifu, Japan.
Department of Internal Medicine, Matsunami General Hospital, Gifu, Japan.
PLoS One. 2021 Jan 15;16(1):e0245625. doi: 10.1371/journal.pone.0245625. eCollection 2021.
Hyporesponsiveness to erythropoiesis-stimulating agent (ESA) may be associated with protein-energy wasting. We investigated the relationship of the ESA resistance index (ERI) and the geriatric nutritional risk index (GNRI) for cardiovascular mortality in hemodialysis (HD) patients.
A total of 180 maintenance HD patients were enrolled. The patients were stratified by the GNRI of 91.2, a previously reported cut-off value, and the ERI of 13.7 (IU/week/kg/g/dL), a cut-off value for predicting cardiovascular-specific mortality, and they were classified into four groups (group 1[G1]: higher GNRI and lower ERI, G2: higher GNRI and higher ERI, G3: lower GNRI and lower ERI, G4: lower GNRI and higher ERI).
The ERI was independently associated with the GNRI (β = -0.271, p = 0.0005). During a median follow-up of 4.6 years, higher ERI and lower GNRI were independently associated with cardiovascular mortality, respectively (adjusted hazard ratio [aHR], 3.10; 95% confidence interval [CI], 1.31-7.34, and aHR, 6.64; 95%CI, 2.60-16.93, respectively). The 7-year survival rates were 96.1%, 70.3%, 77.3%, and 50.1% in G1, G2, G3, and G4, respectively. The aHR values for G4 versus G1 were 12.63 (95%CI, 3.58-44.59). With regards to model discrimination, adding the GNRI alone, the ERI alone, and both to the traditional risk model significantly improved the net reclassification improvement by 0.421, 0.662, and 0.671, respectively. Similar results were obtained for all-cause mortality.
The ERI was independently associated with the GNRI, and could predict cardiovascular mortality in HD patients. Moreover, the combination of GNRI and ERI could improve the predictability for cardiovascular mortality.
促红细胞生成素刺激剂（ESA）反应低下可能与蛋白质-能量消耗有关。我们研究了 ESA 抵抗指数（ERI）和老年营养风险指数（GNRI）与血液透析（HD）患者心血管死亡率的关系。
共纳入 180 例维持性 HD 患者。根据 GNRI 为 91.2（之前报道的截断值）和 ERI 为 13.7（IU/周/kg/g/dL）（预测心血管特异性死亡率的截断值）将患者分层，并将其分为四组（组 1[G1]：较高的 GNRI 和较低的 ERI，G2：较高的 GNRI 和较高的 ERI，G3：较低的 GNRI 和较低的 ERI，G4：较低的 GNRI 和较高的 ERI）。
ERI 与 GNRI 独立相关（β=-0.271，p=0.0005）。在中位随访 4.6 年期间，较高的 ERI 和较低的 GNRI 分别与心血管死亡率独立相关（校正后的危险比[aHR]，3.10；95%置信区间[CI]，1.31-7.34，和 aHR，6.64；95%CI，2.60-16.93）。G1、G2、G3 和 G4 组的 7 年生存率分别为 96.1%、70.3%、77.3%和 50.1%。G4 与 G1 的 aHR 值为 12.63（95%CI，3.58-44.59）。关于模型判别能力，单独添加 GNRI、ERI 以及同时添加两者到传统风险模型中，分别显著提高了净重新分类改善 0.421、0.662 和 0.671。全因死亡率也得到了类似的结果。
ERI 与 GNRI 独立相关，可预测 HD 患者的心血管死亡率。此外，GNRI 和 ERI 的组合可提高心血管死亡率的预测能力。
