Ejiri Hiroki, Tanaka Kenichi, Kimura Hiroshi, Saito Hirotaka, Shimabukuro Michio, Asahi Koichi, Watanabe Tsuyoshi, Kazama Junichiro James
Department of Nephrology and Hypertension, Fukushima Medical University, 1, Hikariga-Oka, Fukushima, 960-1295, Japan.
Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan.
Clin Exp Nephrol. 2025 Apr;29(4):433-443. doi: 10.1007/s10157-024-02586-4. Epub 2024 Nov 5.
Malnutrition, evaluated by nutritional indices, is reportedly related to a poor prognosis in patients with hypertension. However, clinical evidence on which index is more suitable for predicting a kidney prognosis is limited, and it has not been evaluated in hypertension. The aim of the present study was to investigate and compare the predictive values of four nutritional indices: Geriatric Nutritional Risk Index (GNRI); Prognostic Nutrition Index (PNI); Triglycerides × Total cholesterol × Body weight Index (TCBI); and the controlling nutritional status (CONUT) score.
A retrospective, cohort study of 1255 hypertensive patients under care in the Fukushima Cohort Study was conducted. The primary outcome was kidney events, defined as a combination of a 50% decline in eGFR from baseline and renal failure requiring dialysis therapy or kidney transplantation. Kaplan-Meier analyses and multivariate Cox regression analyses were conducted to examine associations between the four nutritional indices and kidney events. The area under the curve (AUC) values of the receiver-operating characteristic curves were also examined to compare the predictive values of these nutritional indices.
Lower GNRI, lower PNI, and higher CONUT score were significantly related to a higher risk of kidney events. GNRI (AUC = 0.729, 95% confidence interval 0.681-0.777) and PNI (AUC = 0.710, 95% confidence interval 0.665-0.756) had significantly higher AUCs for kidney events than the TCBI and CONUT score.
GNRI and PNI showed greater predictive values for kidney events than other nutritional indices in patients with hypertension.
据报道，通过营养指标评估的营养不良与高血压患者的不良预后相关。然而，关于哪种指标更适合预测肾脏预后的临床证据有限，且尚未在高血压患者中进行评估。本研究的目的是调查和比较四种营养指标的预测价值：老年营养风险指数（GNRI）；预后营养指数（PNI）；甘油三酯×总胆固醇×体重指数（TCBI）；以及控制营养状况（CONUT）评分。
对福岛队列研究中接受治疗的1255例高血压患者进行了一项回顾性队列研究。主要结局是肾脏事件，定义为估算肾小球滤过率（eGFR）较基线下降50%，以及需要透析治疗或肾移植的肾衰竭。进行了Kaplan-Meier分析和多变量Cox回归分析，以检验四种营养指标与肾脏事件之间的关联。还检查了受试者工作特征曲线的曲线下面积（AUC）值，以比较这些营养指标的预测价值。
较低的GNRI、较低的PNI和较高的CONUT评分与较高的肾脏事件风险显著相关。GNRI（AUC = 0.729，95%置信区间0.681 - 0.777）和PNI（AUC = 0.710，95%置信区间0.665 - 0.756）对肾脏事件的AUC显著高于TCBI和CONUT评分。
在高血压患者中，GNRI和PNI对肾脏事件的预测价值高于其他营养指标。
