Yuta Suzuki1, Ryota Matsuzawa2, Keika Hoshi3, Yong Mo Koh4, Shohei Yamamoto5, Manae Harada6, Takaaki Watanabe7, Keigo Imamura7, Kentaro Kamiya8, Atsushi Yoshida9, Atsuhiko Matsunaga10. 1. Department of Rehabilitation Science, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan; Department of Rehabilitation, Sagami Circulatory Organ Clinic, Kanagawa, Japan; Advanced Research Course, National Institute of Public Health, Saitama, Japan. 2. Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Hyogo, Japan. 3. Center for Public Health Informatics, National Institute of Public Health, Saitama, Japan; Department of Hygiene, Kitasato University School of Medicine, Kanagawa, Japan. 4. LightStone Corp, Tokyo, Japan; Department of Economics, School of Economic, Senshu University, Tokyo, Japan. 5. Department of Rehabilitation Science, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan; Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan. 6. Department of Rehabilitation, Sagami Circulatory Organ Clinic, Kanagawa, Japan. 7. Department of Rehabilitation Science, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan. 8. Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan. 9. Department of Hemodialysis Center, Sagami Circulatory Organ Clinic, Kanagawa, Japan. 10. Department of Rehabilitation Science, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan. Electronic address: atsuhikonet@gmail.com.
Abstract
OBJECTIVE: Protein-energy wasting is prevalent among patients undergoing dialysis. Hence, identifying an optimal index is necessary for the comprehensive measurement of nutritional status. This study evaluated and compared the prognostic significance of the modified creatinine index (mCI) and geriatric nutritional risk index (GNRI), with the principal aim to identify markers that are more closely associated with clinical events in patients undergoing hemodialysis. METHODS: We performed a retrospective cohort study of 472 patients undergoing maintenance hemodialysis (mean age, 66.4 years; 62.9% males). We evaluated the mCI, GNRI, and their respective rates of change over a 1-year period. The outcome analysis included all-cause death, number and duration of all-cause hospitalizations, and number and duration of hospitalizations due to cardiovascular disease. In addition, we analyzed the associations of the mCI, GNRI, and their trajectories with clinical outcomes using Cox proportional hazard regression and negative binomial regression. RESULTS: Over a median 3.6-year follow-up, both the lower mCI (hazard ratio 3.00; 95% confidence interval 2.19, 4.09) and lower GNRI (hazard ratio 1.76; 95% confidence interval 1.45, 2.13) per 1 standard deviation decrease were associated with a higher risk of all-cause death. However, a lower mCI was consistently associated with a higher risk of hospitalization, whereas the GNRI was poorly associated with the risk of hospitalization after adjusting for covariates. Furthermore, although a decline in the mCI over time was associated with a higher risk of each adverse event, a significant association between the change in GNRI and clinical events was not detected. CONCLUSION: The mCI at one timepoint and its trajectory had consistently stronger associations with clinical events than the GNRI in patients undergoing hemodialysis. This study further emphasizes the importance of risk screening using a marker of nutritional status in patients undergoing hemodialysis.
OBJECTIVE: Protein-energy wasting is prevalent among patients undergoing dialysis. Hence, identifying an optimal index is necessary for the comprehensive measurement of nutritional status. This study evaluated and compared the prognostic significance of the modified creatinine index (mCI) and geriatric nutritional risk index (GNRI), with the principal aim to identify markers that are more closely associated with clinical events in patients undergoing hemodialysis. METHODS: We performed a retrospective cohort study of 472 patients undergoing maintenance hemodialysis (mean age, 66.4 years; 62.9% males). We evaluated the mCI, GNRI, and their respective rates of change over a 1-year period. The outcome analysis included all-cause death, number and duration of all-cause hospitalizations, and number and duration of hospitalizations due to cardiovascular disease. In addition, we analyzed the associations of the mCI, GNRI, and their trajectories with clinical outcomes using Cox proportional hazard regression and negative binomial regression. RESULTS: Over a median 3.6-year follow-up, both the lower mCI (hazard ratio 3.00; 95% confidence interval 2.19, 4.09) and lower GNRI (hazard ratio 1.76; 95% confidence interval 1.45, 2.13) per 1 standard deviation decrease were associated with a higher risk of all-cause death. However, a lower mCI was consistently associated with a higher risk of hospitalization, whereas the GNRI was poorly associated with the risk of hospitalization after adjusting for covariates. Furthermore, although a decline in the mCI over time was associated with a higher risk of each adverse event, a significant association between the change in GNRI and clinical events was not detected. CONCLUSION: The mCI at one timepoint and its trajectory had consistently stronger associations with clinical events than the GNRI in patients undergoing hemodialysis. This study further emphasizes the importance of risk screening using a marker of nutritional status in patients undergoing hemodialysis.