Geriatric nutritional risk index accurately predicts cardiovascular mortality in incident hemodialysis patients

Hiroshi Takahashi, Yasuhiko Ito, Hideki Ishii, Toru Aoyama, Daisuke Kamoi, Hirotake Kasuga, Kaoru Yasuda, Shoichi Maruyama, Seiichi Matsuo, Toyoaki Murohara, Yukio Yuzawa

Research output: Contribution to journalArticle

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Abstract

Background: Cardiovascular disease (CVD) is a leading cause of death in end-stage renal disease (ESRD) patients. Protein-energy wasting (PEW) or malnutrition is common in this population, and is associated with increasing risk of mortality. The geriatric nutritional risk index (GNRI) has been developed as a tool to assess the nutritional risk, and is associated with mortality not only in elderly patients but also in ESRD patients. However, whether the GNRI could predict the mortality due to CVD remains unclear in this population. We investigated the prognostic value of GNRI at initiation of hemodialysis (HD) therapy for CVD mortality in a large cohort of ESRD patients. Methods: Serum albumin, body weight, and height for calculating GNRI were measured in 1568 ESRD patients. Thereafter, the patients were divided into quartiles according to GNRI levels [quartile 1 (Q1): <84.9; Q2: 85.0-91.1; Q3: 91.2-97.2; and Q4: >97.3], and were followed up for up to 10 years. Results: GNRI levels independently correlated with serum C-reactive-protein levels (β= -0.126, p<. 0.0001). Rates of freedom from CVD mortality for 10 years were 57.9%, 73.3%, 80.8%, and 89.2% in Q1, Q2, Q3, and Q4, respectively (p<. 0.0001). The GNRI was an independent predictor of CVD mortality (hazard ratio 3.42, 95% confidence interval 2.05-5.70, p<. 0.0001 for Q1 vs. Q4). C-index was also greater in an established CVD risk model with GNRI (0.749) compared to that with albumin (0.730), body mass index (0.732), and alone (0.710). Similar results were observed for all-cause mortality. Conclusion: GNRI at initiation of HD therapy could predict CVD mortality with incremental value of the predictability compared to serum albumin and body mass index in ESRD patients.

Original languageEnglish
Pages (from-to)32-36
Number of pages5
JournalJournal of cardiology
Volume64
Issue number1
DOIs
Publication statusPublished - 01-01-2014

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Nutrition Assessment
Geriatrics
Renal Dialysis
Mortality
Cardiovascular Diseases
Chronic Kidney Failure
Serum Albumin
Body Mass Index
Body Height
Malnutrition
C-Reactive Protein
Population
Blood Proteins
Cause of Death
Albumins
Body Weight

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Takahashi, Hiroshi ; Ito, Yasuhiko ; Ishii, Hideki ; Aoyama, Toru ; Kamoi, Daisuke ; Kasuga, Hirotake ; Yasuda, Kaoru ; Maruyama, Shoichi ; Matsuo, Seiichi ; Murohara, Toyoaki ; Yuzawa, Yukio. / Geriatric nutritional risk index accurately predicts cardiovascular mortality in incident hemodialysis patients. In: Journal of cardiology. 2014 ; Vol. 64, No. 1. pp. 32-36.
@article{1a37644f2e2b49ff8f34465b619bba16,
title = "Geriatric nutritional risk index accurately predicts cardiovascular mortality in incident hemodialysis patients",
abstract = "Background: Cardiovascular disease (CVD) is a leading cause of death in end-stage renal disease (ESRD) patients. Protein-energy wasting (PEW) or malnutrition is common in this population, and is associated with increasing risk of mortality. The geriatric nutritional risk index (GNRI) has been developed as a tool to assess the nutritional risk, and is associated with mortality not only in elderly patients but also in ESRD patients. However, whether the GNRI could predict the mortality due to CVD remains unclear in this population. We investigated the prognostic value of GNRI at initiation of hemodialysis (HD) therapy for CVD mortality in a large cohort of ESRD patients. Methods: Serum albumin, body weight, and height for calculating GNRI were measured in 1568 ESRD patients. Thereafter, the patients were divided into quartiles according to GNRI levels [quartile 1 (Q1): <84.9; Q2: 85.0-91.1; Q3: 91.2-97.2; and Q4: >97.3], and were followed up for up to 10 years. Results: GNRI levels independently correlated with serum C-reactive-protein levels (β= -0.126, p<. 0.0001). Rates of freedom from CVD mortality for 10 years were 57.9{\%}, 73.3{\%}, 80.8{\%}, and 89.2{\%} in Q1, Q2, Q3, and Q4, respectively (p<. 0.0001). The GNRI was an independent predictor of CVD mortality (hazard ratio 3.42, 95{\%} confidence interval 2.05-5.70, p<. 0.0001 for Q1 vs. Q4). C-index was also greater in an established CVD risk model with GNRI (0.749) compared to that with albumin (0.730), body mass index (0.732), and alone (0.710). Similar results were observed for all-cause mortality. Conclusion: GNRI at initiation of HD therapy could predict CVD mortality with incremental value of the predictability compared to serum albumin and body mass index in ESRD patients.",
author = "Hiroshi Takahashi and Yasuhiko Ito and Hideki Ishii and Toru Aoyama and Daisuke Kamoi and Hirotake Kasuga and Kaoru Yasuda and Shoichi Maruyama and Seiichi Matsuo and Toyoaki Murohara and Yukio Yuzawa",
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Takahashi, H, Ito, Y, Ishii, H, Aoyama, T, Kamoi, D, Kasuga, H, Yasuda, K, Maruyama, S, Matsuo, S, Murohara, T & Yuzawa, Y 2014, 'Geriatric nutritional risk index accurately predicts cardiovascular mortality in incident hemodialysis patients', Journal of cardiology, vol. 64, no. 1, pp. 32-36. https://doi.org/10.1016/j.jjcc.2013.10.018

Geriatric nutritional risk index accurately predicts cardiovascular mortality in incident hemodialysis patients. / Takahashi, Hiroshi; Ito, Yasuhiko; Ishii, Hideki; Aoyama, Toru; Kamoi, Daisuke; Kasuga, Hirotake; Yasuda, Kaoru; Maruyama, Shoichi; Matsuo, Seiichi; Murohara, Toyoaki; Yuzawa, Yukio.

In: Journal of cardiology, Vol. 64, No. 1, 01.01.2014, p. 32-36.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Geriatric nutritional risk index accurately predicts cardiovascular mortality in incident hemodialysis patients

AU - Takahashi, Hiroshi

AU - Ito, Yasuhiko

AU - Ishii, Hideki

AU - Aoyama, Toru

AU - Kamoi, Daisuke

AU - Kasuga, Hirotake

AU - Yasuda, Kaoru

AU - Maruyama, Shoichi

AU - Matsuo, Seiichi

AU - Murohara, Toyoaki

AU - Yuzawa, Yukio

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background: Cardiovascular disease (CVD) is a leading cause of death in end-stage renal disease (ESRD) patients. Protein-energy wasting (PEW) or malnutrition is common in this population, and is associated with increasing risk of mortality. The geriatric nutritional risk index (GNRI) has been developed as a tool to assess the nutritional risk, and is associated with mortality not only in elderly patients but also in ESRD patients. However, whether the GNRI could predict the mortality due to CVD remains unclear in this population. We investigated the prognostic value of GNRI at initiation of hemodialysis (HD) therapy for CVD mortality in a large cohort of ESRD patients. Methods: Serum albumin, body weight, and height for calculating GNRI were measured in 1568 ESRD patients. Thereafter, the patients were divided into quartiles according to GNRI levels [quartile 1 (Q1): <84.9; Q2: 85.0-91.1; Q3: 91.2-97.2; and Q4: >97.3], and were followed up for up to 10 years. Results: GNRI levels independently correlated with serum C-reactive-protein levels (β= -0.126, p<. 0.0001). Rates of freedom from CVD mortality for 10 years were 57.9%, 73.3%, 80.8%, and 89.2% in Q1, Q2, Q3, and Q4, respectively (p<. 0.0001). The GNRI was an independent predictor of CVD mortality (hazard ratio 3.42, 95% confidence interval 2.05-5.70, p<. 0.0001 for Q1 vs. Q4). C-index was also greater in an established CVD risk model with GNRI (0.749) compared to that with albumin (0.730), body mass index (0.732), and alone (0.710). Similar results were observed for all-cause mortality. Conclusion: GNRI at initiation of HD therapy could predict CVD mortality with incremental value of the predictability compared to serum albumin and body mass index in ESRD patients.

AB - Background: Cardiovascular disease (CVD) is a leading cause of death in end-stage renal disease (ESRD) patients. Protein-energy wasting (PEW) or malnutrition is common in this population, and is associated with increasing risk of mortality. The geriatric nutritional risk index (GNRI) has been developed as a tool to assess the nutritional risk, and is associated with mortality not only in elderly patients but also in ESRD patients. However, whether the GNRI could predict the mortality due to CVD remains unclear in this population. We investigated the prognostic value of GNRI at initiation of hemodialysis (HD) therapy for CVD mortality in a large cohort of ESRD patients. Methods: Serum albumin, body weight, and height for calculating GNRI were measured in 1568 ESRD patients. Thereafter, the patients were divided into quartiles according to GNRI levels [quartile 1 (Q1): <84.9; Q2: 85.0-91.1; Q3: 91.2-97.2; and Q4: >97.3], and were followed up for up to 10 years. Results: GNRI levels independently correlated with serum C-reactive-protein levels (β= -0.126, p<. 0.0001). Rates of freedom from CVD mortality for 10 years were 57.9%, 73.3%, 80.8%, and 89.2% in Q1, Q2, Q3, and Q4, respectively (p<. 0.0001). The GNRI was an independent predictor of CVD mortality (hazard ratio 3.42, 95% confidence interval 2.05-5.70, p<. 0.0001 for Q1 vs. Q4). C-index was also greater in an established CVD risk model with GNRI (0.749) compared to that with albumin (0.730), body mass index (0.732), and alone (0.710). Similar results were observed for all-cause mortality. Conclusion: GNRI at initiation of HD therapy could predict CVD mortality with incremental value of the predictability compared to serum albumin and body mass index in ESRD patients.

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U2 - 10.1016/j.jjcc.2013.10.018

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