Mori Katsuhito, Yamamoto Yosuke, Hanafusa Norio, Yamamoto Suguru, Fukuma Shingo, Onishi Yoshihiro, Emoto Masanori, Inaba Masaaki
Department of Nephrology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
J Ren Nutr. 2025 Jan;35(1):187-195. doi: 10.1053/j.jrn.2024.07.017. Epub 2024 Jul 29.
Patients undergoing dialysis frequently experience hospitalization due to cardiovascular disease (CVD) and infection. This population is also at high risk of rehospitalization and subsequent death. In addition to serious outcomes, hospitalization incurs substantial medical cost. Prevention of hospitalization is accordingly an urgent matter. Here, we examined whether nutritional disorder was associated with hospitalization and subsequent death.
The study was conducted under a prospective design using data from the Japanese Dialysis Outcomes and Practice Pattern Study. The exposure was the Nutritional Risk Index for Japanese Hemodialysis (NRI-JH), through which patients were divided into low-, medium-, and high-risk groups, with the low-risk group as referent. The primary outcome was CVD-related or infection-related hospitalization. Secondary outcome was all-cause mortality. For exploratory analyses, the associations of baseline or latest NRI-JH just before hospitalization, with death after hospitalizations, were examined.
Of 4021 patients, 566 patients had CVD-related hospitalization and 375 had infection-related hospitalization during a median follow-up of 2.6 years. NRI-JH at baseline was significantly associated with infection-related hospitalization but not with CVD-related hospitalization, in multivariable Cox models (hazard ratio [HR] 1.46, 95% confidential interval [CI]: 1.09 to 1.97, P = .012 for medium-risk vs. low-risk group) (HR 2.46, 95% CI: 1.81 to 3.35, P < .001 for high-risk vs. low-risk group). NRI-JH was also associated with all-cause mortality. In addition, the baseline and latest high-risk NRI-JH groups were significantly associated with death after both CVD-related and infection-related hospitalizations.
A higher nutritional risk as evaluated by NRI-JH was associated with infection-related hospitalization but not with CVD-related hospitalization. However, NRI-JH was significantly associated with death after both CVD-related and infection-related hospitalizations, suggesting that nutritional risk may be separately involved in hospitalization or subsequent death. NRI-JH may be useful in the planning of individual care to improve outcomes.
接受透析治疗的患者常因心血管疾病（CVD）和感染而住院。这一人群再次住院及随后死亡的风险也很高。除了严重后果外，住院还会产生巨额医疗费用。因此，预防住院是当务之急。在此，我们研究了营养失调是否与住院及随后的死亡有关。
本研究采用前瞻性设计，使用来自日本透析结果与实践模式研究的数据。暴露因素为日本血液透析营养风险指数（NRI-JH），通过该指数将患者分为低风险、中风险和高风险组，以低风险组作为对照。主要结局是CVD相关或感染相关的住院治疗。次要结局是全因死亡率。为进行探索性分析，研究了住院前基线或最新的NRI-JH与住院后死亡之间的关联。
在4021例患者中，中位随访2.6年期间，566例患者发生了CVD相关住院，375例患者发生了感染相关住院。在多变量Cox模型中，基线时的NRI-JH与感染相关住院显著相关，但与CVD相关住院无关（中风险组与低风险组相比，风险比[HR]为1.46，95%置信区间[CI]：1.09至1.97，P = 0.012）（高风险组与低风险组相比，HR为2.46，95%CI：1.81至3.35，P < 0.001）。NRI-JH也与全因死亡率相关。此外，基线和最新的高风险NRI-JH组与CVD相关和感染相关住院后的死亡均显著相关。
NRI-JH评估的较高营养风险与感染相关住院有关，但与CVD相关住院无关。然而，NRI-JH与CVD相关和感染相关住院后的死亡均显著相关，这表明营养风险可能分别与住院或随后的死亡有关。NRI-JH可能有助于制定个体化护理计划以改善结局。
