Song Gi Hyun, Choi Han Byul, Park Hayne Cho, Kim Do Hyoung, Lee Young-Ki, Cho AJin
Department of Internal Medicine, Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea.
Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea.
Nutrients. 2024 Feb 26;16(5):652. doi: 10.3390/nu16050652.
The Geriatric Nutritional Risk Index is a simple nutritional screening method, and this study aimed to investigate the association between the initial Geriatric Nutritional Risk Index and all-cause mortality in incident patients in the first year after the initiation of hemodialysis.
This study is a retrospective cohort study and used the Korean Renal Data System database. Patients who were eligible for Geriatric Nutritional Risk Index assessment and underwent hemodialysis from January 2016 to December 2019 were included. The primary outcome was all-cause mortality, and outcome evaluation was performed in December 2020. A Cox proportional hazard model was used to analyze the association between the Geriatric Nutritional Risk Index and mortality.
A total of 10,545 patients were included, and the mean age was 63.9 ± 3.7 years. The patients were divided into four groups by the quartile of the Geriatric Nutritional Risk Index with a mean value of 96.2 ± 8.2. During the study period, 545 (5.2%) deaths occurred. The surviving patients had higher Geriatric Nutritional Risk Index values than ones who died in the first year of hemodialysis initiation (96.6 ± 7.5 vs. 88.2 ± 9.3, < 0.001). Quartile 1 (Geriatric Nutritional Risk Index < 91.8) showed a significantly increased risk of all-cause (Hazard Ratio: 2.56; 95% Confidence Interval: 2.13-3.09; < 0.001) and cardiovascular mortality (Hazard Ratio: 22.29; 95% Confidence Interval: 1.71- 3.08; < 0.001) at the first year in comparison with Quartile 4 (Geriatric Nutritional Risk Index ≥ 101.3). In areas under the receiver-operating characteristic curves of all-cause mortality, the Geriatric Nutritional Risk Index model improved predictive values, compared to the baseline model. The area with the Geriatric Nutritional Risk Index model was significantly higher than the one with a model including albumin or body mass index ( < 0.001).
These findings suggest that a low Geriatric Nutritional Risk Index (<91.8) is associated with first-year all-cause and cardiovascular mortality in patients who start hemodialysis and may be a useful and reproducible tool for assessing prognoses in this population.
老年营养风险指数是一种简单的营养筛查方法，本研究旨在探讨初始老年营养风险指数与血液透析开始后第一年新发病患者全因死亡率之间的关联。
本研究为回顾性队列研究，使用韩国肾脏数据系统数据库。纳入2016年1月至2019年12月期间符合老年营养风险指数评估条件并接受血液透析的患者。主要结局为全因死亡率，于2020年12月进行结局评估。采用Cox比例风险模型分析老年营养风险指数与死亡率之间的关联。
共纳入10545例患者，平均年龄为63.9±3.7岁。根据老年营养风险指数的四分位数将患者分为四组，平均值为96.2±8.2。在研究期间，发生了545例（5.2%）死亡。存活患者的老年营养风险指数值高于血液透析开始后第一年死亡的患者（96.6±7.5对88.2±9.3，<0.001）。与四分位数4（老年营养风险指数≥101.3）相比，四分位数1（老年营养风险指数<91.8）在第一年显示全因（风险比：2.56；95%置信区间：2.13 - 3.09；<0.001）和心血管死亡率（风险比：2.29；95%置信区间：1.71 - 3.08；<0.001）显著增加。在全因死亡率的受试者工作特征曲线下面积方面，与基线模型相比，老年营养风险指数模型提高了预测价值。老年营养风险指数模型的面积显著高于包含白蛋白或体重指数的模型（<0.001）。
这些发现表明，低老年营养风险指数（<91.8）与开始血液透析患者的第一年全因和心血管死亡率相关，可能是评估该人群预后的一种有用且可重复的工具。
