Advertisement

Geriatric nutrition risk index is associated with renal progression, cardiovascular events and all-cause mortality in chronic kidney disease

  • Jiachuan Xiong
  • Min Wang
  • Jinwei Wang
  • Ke Yang
  • Yu Shi
  • Jingbo Zhang
  • Bo Zhang
  • Luxia Zhang
  • Jinghong ZhaoEmail author
  • The Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE)
Original Article
  • 33 Downloads

Abstract

Background

Malnutrition is common and associated with poor outcomes in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Recently, the geriatric nutritional risk index (GNRI) was reported as a novel tool for evaluating nutritional status. However, the association between GNRI and renal outcome, cardiovascular (CVD) events, and mortality in patients with CKD remains unclear.

Methods

A prospective cohort study with adult patients with CKD stages 1–4 was conducted at 39 centers around China starting in 2011. Patients were divided into quartiles (Q1, Q2, Q3, and Q4) according to their GNRI category.

Results

A total of 2791 CKD patients within a median follow-up of 4.38 years were included. A low GNRI quartile was independently associated with progression to ESRD, CVD events, and overall mortality. Compared to that in the Q1 group (the reference group), belonging to a higher GNRI quartile significantly reduced the risk of progression to ESRD in the crude and multivariate-adjusted models. Moreover, a significant inverse association was found between those in the high GNRI quartiles and overall mortality among patients with CKD (HR 0.25; 95% CI 0.15–0.43; p = 0.0007, Q4 vs. Q1) after multivariate adjustment. In addition, there was also a significant association between GNRI and CVD events (HR 0.57; 95% CI 0.39–0.84; p = 0.005, Q4 vs. Q1). Moreover, after adjusting for other confounders, only the Q3 group remained significantly fewer CVD events (HR 0.44; 95% CI 0.19–0.98; p = 0.04).

Conclusions

These findings suggest that GNRI might be a useful prognostic tool for patients with CKD.

Keywords

Geriatric nutritional risk index Chronic kidney disease End-stage renal disease Mortality Cardiovascular disease 

Notes

Acknowledgements

The authors would like to express gratitude to every member of the C-STRIDE group for their close collaboration. The Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE) Collaborators: Peking University First Hospital: Ming-Hui Zhao, Luxia Zhang; the Affiliated Hospital of Hubei Traditional Chinese Medical College: Xiaoqin Wang, Jun Yuan; the Xiangya Hospital of Central South University: Qiaoling Zhou, Qiongjing Yuan; General Hospital of Ningxia Medical University: Menghua Chen, Xiaoling Zhou; the Second Hospital of Hebei Medical University: Shuxia Fu, Shaomei Li; Guizhou Provincial People’s Hospital: Yan Zha, Rongsai Huang; the First Affiliated Hospital of Zhengzhou University: Zhangsuo Liu, JunJun Zhang; Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital: Li Wang, Lei Pu; the First Affiliated Hospital of Xinjiang University of Medicine: Jian Liu, Suhua Li; Peking University Shenzhen Hospital: Zuying Xiong, Wei Liang; Xinqiao Hospital: Jinghong Zhao, Jiao Mu; the Second Affiliated Hospital of Kunming Medical College: Xiyan Lian, Yunjuan Liao; the First Affiliated Hospital of Chongqing University of Medicine: Hua Gan, Liping Liao; Shandong Provincial Hospital: Rong Wang, Zhimei Lv; the First Affiliated Hospital of Guangxi University of Medicine: Yunhua Liao, Ling Pan; the First Affiliated Hospital of the Medical College, Shihezi University: Xiaoping Yang, Zhifeng Lin; Yuxi City People’s Hospital: Zongwu Tong, Yun Zhu; Beilun People’s Hospital in Ningbo: Qiang He, Fuquan Wu; the Second Affiliated Hospital of Tianjin University of Medicine: Rong Li, Kai Rong; the First Affiliated Hospital of Baotou Medical College: Caili Wang, Yanhui Zhang; Peking University Third Hospital: Yue Wang, Wen Tang; Beijing Hospital of Ministry of Health: Hua Wu, Ban Zhao; the Second Hospital of Shanxi University of Medicine: Rongshan Li, Lihua Wang; Shengjing Hospital of China Medical University: Detian Li, Feng Du; the First Affiliated Hospital of Anhui University of Medicine: Yonggui Wu, Wei Zhang; Tianjin Medical University General Hospital: Shan Lin, Pengcheng Xu; the First Affiliated Hospital of Dalian University of Medicine: Hongli Lin; Shandong University Qilu Hospital: Zhao Hu, Fei Pei; the Affiliated Hospital of Hebei University: Haisong Zhang, Yan Gao; Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine: Luying Sun, Xia Li; Chifeng Second Hospital: Wenke Wang, Fengling Lv; the Second Affiliated Hospital of Anhui University of Medicine: Deguang Wang, Xuerong Wang; Qianfoshan Hospital: Dongmei Xu, Lijun Tang; China Rehabilitation Research Center, Beijing Boai Hospital: Yingchun Ma, Tingting Wang; West China Hospital of Sichuan University: Ping Fu, Tingli Wang; the First Affiliated Hospital with Nanjing Medical University: Changying Xing, Chengning Zhang; Minhang Central Hospital: Xudong Xu, Haidong He; the Second Affiliated Hospital of Chongqing University of Medicine: Xiaohui Liao, Shuqin Xie; the Affiliated Hospital of Chengde Medical Colledge: Guicai Hu, Lan Huang.

Compliance with ethical standards

Conflict of interest

All the authors declared no competing interests.

Ethical approval

The study was approved by the Ethics Committee of Peking University First Hospital and was in adherence with the Declaration of Helsinki.

References

  1. 1.
    Webster AC, Nagler EV, Morton RL et al (2017) Chronic kidney disease. The Lancet 389:1238–1252CrossRefGoogle Scholar
  2. 2.
    Josef C, Tanvir Chowdhury T, Kunihiro M et al (2014) Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality. JAMA 311:2518–2531CrossRefGoogle Scholar
  3. 3.
    Vasil P, Ali N, Gabriel C (2014) Dyslipidemia, malnutrition, inflammation, cardiovascular disease and mortality in chronic kidney disease. Curr Opin Lipidol 25:54–60CrossRefGoogle Scholar
  4. 4.
    Ikizler TA, Cano NJ, Franch H et al (2013) Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism. Kidney Int 84:1096–1107PubMedCrossRefGoogle Scholar
  5. 5.
    Rees K, Dyakova M, Wilson N et al (2013) Dietary advice for reducing cardiovascular risk. Cochrane Database Syst Rev (12):CD002128.  https://doi.org/10.1002/14651858.CD002128
  6. 6.
    Cupisti A, Brunori G, Di Iorio BR et al (2018) Nutritional treatment of advanced CKD: twenty consensus statements. J Nephrol 31:457–473PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Kovesdy CP, Kopple JD, Kamyar KZ (2013) Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease: reconciling low protein intake with nutritional therapy. Am J Clin Nutr 97:1163–1177PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Sabatino A, Regolisti G, Gandolfini I et al (2017) Diet and enteral nutrition in patients with chronic kidney disease not on dialysis: a review focusing on fat, fiber and protein intake. J Nephrol 30:743–754PubMedCrossRefGoogle Scholar
  9. 9.
    Carrero JJ, Stenvinkel P, Cuppari L et al (2013) Etiology of the protein-energy wasting syndrome in chronic kidney disease: a consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM). J Ren Nutr 23:77–90PubMedCrossRefGoogle Scholar
  10. 10.
    Gutiérrez OM, Paul M, Rizk DV et al (2014) Dietary patterns and risk of death and progression to ESRD in individuals with CKD: a cohort study. Am J Kidney Dis 64:204–213PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Liu Y, Kuczmarski MF, Nava MB et al (2016) Dietary habits and risk of kidney function decline in an urban population. J Ren Nutr 27:16–25PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Kalantar-Zadeh K, Joel DK, Block Gladys et al (2001) A malnutrition-inflammation score is correlated with mortality in maintenance hemodialysis patients. Am J Kidney Dis 38:1251–1263PubMedCrossRefGoogle Scholar
  13. 13.
    Cereda E, Vanotti A (2007) The new Geriatric Nutritional Risk Index is a good predictor of muscle dysfunction in institutionalized older patients. Clin Nutr 26:78–83PubMedCrossRefGoogle Scholar
  14. 14.
    Kobayashi I, Ishimura E, Kato Y et al (2010) Geriatric Nutritional Risk Index, a simplified nutritional screening index, is a significant predictor of mortality in chronic dialysis patients. Nephrol Dial Transplant 25:3361–3365PubMedCrossRefGoogle Scholar
  15. 15.
    Harada K, Suzuki S, Ishii H et al (2017) Nutrition status predicts severity of vascular calcification in non-dialyzed chronic kidney disease. Circ J 81:316–321PubMedCrossRefGoogle Scholar
  16. 16.
    Hyun YY, Lee KB, Han SH et al (2017) Nutritional status in adults with predialysis chronic kidney disease: KNOW-CKD study. J Korean Med Sci 32:257–263PubMedCrossRefGoogle Scholar
  17. 17.
    Xiong J, Wang M, Zhang Y et al (2018) Association of geriatric nutritional risk index with mortality in hemodialysis patients: a meta-analysis of cohort studies. Kidney Blood Press Res 43:1878–1889PubMedCrossRefGoogle Scholar
  18. 18.
    Kiuchi A, Ohashi Y, Tai R et al (2016) Association between low dietary protein intake and geriatric nutrition risk index in patients with chronic kidney disease: a retrospective single-center cohort study. Nutrients 8(10):662PubMedCentralCrossRefPubMedGoogle Scholar
  19. 19.
    Gao B, Zhang L, Wang H et al (2014) Chinese cohort study of chronic kidney disease: design and methods. Chin Med J 127:2180–2185PubMedPubMedCentralGoogle Scholar
  20. 20.
    Yuan J, Zou XR, Han SP et al (2017) Prevalence and risk factors for cardiovascular disease among chronic kidney disease patients: results from the Chinese cohort study of chronic kidney disease (C-STRIDE). BMC Nephrol 18(1):23PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Ma YC, Zuo L, Chen JH et al (2006) Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol 17:2937–2944PubMedCrossRefGoogle Scholar
  22. 22.
    Stevens PE, Adeera L (2013) Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med 158:825–830PubMedCrossRefGoogle Scholar
  23. 23.
    Peeters MJ, van den Brand JA, van Zuilen AD et al (2017) Abdominal aortic calcification in patients with CKD. J Nephrol 30:109–118PubMedCrossRefGoogle Scholar
  24. 24.
    Bouillanne O, Morineau GC, Coulombel I et al (2005) Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr 82:777–783PubMedCrossRefGoogle Scholar
  25. 25.
    Komatsu M, Okazaki M, Tsuchiya K et al (2015) Geriatric nutritional risk index is a simple predictor of mortality in chronic hemodialysis patients. Blood Purif 39:281–287PubMedCrossRefGoogle Scholar
  26. 26.
    Kovesdy CP, Kamyar KZ (2009) Why is protein-energy wasting associated with mortality in chronic kidney disease? Semin Nephrol 29:3–14PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Kovesdy CP, Furth SL, Zoccali C (2017) Obesity and kidney disease: hidden consequences of the epidemic. J Nephrol 30:1–10PubMedCrossRefGoogle Scholar
  28. 28.
    Rivara MB, Vanessa R, Kamyar KZ et al (2015) Uncorrected and albumin-corrected calcium, phosphorus, and mortality in patients undergoing maintenance dialysis. J Am Soc Nephrol 26:1671–1681PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Takahashi H, Ito Y, Ishii H et al (2014) Geriatric nutritional risk index accurately predicts cardiovascular mortality in incident hemodialysis patients. J Cardiol 64:32–36PubMedCrossRefGoogle Scholar
  30. 30.
    Beberashvili I, Azar A, Sinuani I et al (2016) Geriatric nutritional risk index, muscle function, quality of life and clinical outcome in hemodialysis patients. Clin Nutr 35:1522–1529PubMedCrossRefGoogle Scholar
  31. 31.
    Heimbürger O, Qureshi AR, Blaner WS et al (2000) Hand-grip muscle strength, lean body mass, and plasma proteins as markers of nutritional status in patients with chronic renal failure close to start of dialysis therapy. Am J Kidney Dis 36:1213–1225PubMedCrossRefGoogle Scholar
  32. 32.
    Hakim RM, Levin N (1993) Malnutrition in hemodialysis patients. Am J Kidney Dis 21:125–137PubMedCrossRefGoogle Scholar
  33. 33.
    Acchiardo SR, Moore LW, Latour PA (1983) Malnutrition as the main factor in morbidity and mortality of hemodialysis patients. Kidney Int Suppl 16:S199PubMedGoogle Scholar
  34. 34.
    Bergström J (1995) Nutrition and mortality in hemodialysis. J Am Soc Nephrol 6:1329–1341PubMedGoogle Scholar
  35. 35.
    Oliveira CMC, Kubrusly M, Lima AT et al (2015) Correlation between nutritional markers and appetite self-assessments in hemodialysis patients. J Ren Nutr 25:301–307PubMedCrossRefGoogle Scholar
  36. 36.
    Park JH, Kim SB, Shin HS et al (2012) Geriatric nutritional risk index may be a significant predictor of mortality in Korean hemodialysis patients: a single center study. Ther Apher Dial 16:121–126PubMedCrossRefGoogle Scholar
  37. 37.
    Sirajedine K, Fardous R, Al Adib M et al (2012) Interest of geriatric nutritional risk index for mortality prediction in hemodialysis patients: preliminary study. Nephrol Ther 8:226–230PubMedCrossRefGoogle Scholar
  38. 38.
    Panichi V, Cupisti A, Rosati A et al (2014) Geriatric nutritional risk index is a strong predictor of mortality in hemodialysis patients: data from the Riscavid cohort. J Nephrol 27:193–201PubMedCrossRefGoogle Scholar
  39. 39.
    Matsukuma Y, Tanaka S, Taniguchi M et al (2019) Association of geriatric nutritional risk index with infection-related mortality in patients undergoing hemodialysis: The Q-Cohort study. Clin Nutr 38:279–287PubMedCrossRefGoogle Scholar
  40. 40.
    Fukuma S, Ikenoue T, Akizawa T et al (2017) Impact of nutritional index on the association between phosphorus concentrations and mortality in haemodialysis patients: a cohort study from dialysis outcomes and practice pattern study in Japan. BMJ Open 7:e016682PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Seok Hui K, Kyu Hyang C, Jong Won P et al (2013) Geriatric nutritional risk index as a prognostic factor in peritoneal dialysis patients. Perit Dial Int 33:405–410CrossRefGoogle Scholar
  42. 42.
    Kuo IC, Huang JC, Wu PY et al (2017) A low geriatric nutrition risk index is associated with progression to dialysis in patients with chronic kidney disease. Nutrients 9:1228PubMedCentralCrossRefPubMedGoogle Scholar
  43. 43.
    Ikizler TA (2004) Role of nutrition for cardiovascular risk reduction in chronic kidney disease patients. Adv Chronic Kidney Dis 11:162–171PubMedCrossRefGoogle Scholar
  44. 44.
    Chen HY, Chiu YL, Hsu SP et al (2014) Fetuin A/nutritional status predicts cardiovascular outcomes and survival in hemodialysis patients. Am J Nephrol 40:233–241PubMedCrossRefGoogle Scholar
  45. 45.
    Mi JL, Kwon YE, Park KS et al (2017) Changes in geriatric nutritional risk index and risk of major adverse cardiac and cerebrovascular events in incident peritoneal dialysis patients. Kidney Res Clin Pract 36:377–386CrossRefGoogle Scholar
  46. 46.
    Stenvinkel P, Heimburger O, Paultre F et al (1999) Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int 55:1899–1911PubMedCrossRefGoogle Scholar

Copyright information

© Italian Society of Nephrology 2019

Authors and Affiliations

  • Jiachuan Xiong
    • 1
  • Min Wang
    • 2
  • Jinwei Wang
    • 3
    • 4
  • Ke Yang
    • 1
  • Yu Shi
    • 1
  • Jingbo Zhang
    • 1
  • Bo Zhang
    • 1
  • Luxia Zhang
    • 3
    • 4
  • Jinghong Zhao
    • 1
    Email author
  • The Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE)
  1. 1.Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Kidney Center of PLA, Xinqiao HospitalArmy Medical University (Third Military Medical University)ChongqingPeople’s Republic of China
  2. 2.Department of Otorhinolaryngology and Head-Neck Surgery, Xinqiao HospitalThird Military Medical UniversityChongqingPeople’s Republic of China
  3. 3.Renal Division, Department of MedicinePeking University First HospitalBeijingChina
  4. 4.Peking University Institute of Nephrology, Peking University Health Science CenterBeijingChina

Personalised recommendations