Geriatric nutritional risk index as a screening tool for malnutrition in patients on chronic peritoneal dialysis.
BACKGROUND
Malnutrition is common among peritoneal dialysis (PD) patients. Recently, the Geriatric Nutrition Risk Index (GNRI) was found to be a reliable tool for screening malnutrition in hemodialysis patients. However, the GNRI has not been validated in PD patients.


METHODS
We studied 314 unselected, adult PD patients from a single dialysis unit. We compared their GNRI scores with their comprehensive Malnutrition-Inflammation Scores (MIS) and 7-point Subjective Global Assessment (SGA) scores. We randomly selected 106 patients for a repeated assessment, and the changes in their three indices were compared.


RESULTS
Baseline GNRI was significantly correlated with MIS (r = -0.487, P < .0001) and SGA (r = 0.234, P < .0001). When MIS >or=6 was defined as malnutrition, the sensitivity and specificity of GNRI <or=93 in predicting malnutrition were 68.0% and 67.7%, respectively. When SGA <or=5 was used to define malnutrition, the sensitivity and specificity were 54.5% and 71.1%, respectively. The change in GNRI was correlated with the change in MIS (r = -0.244, P = .012) and overall SGA score (r = 0.266, P = .006), respectively. When an increase in MIS was defined as a worsening of nutrition, the sensitivity and specificity of GNRI were 45.7% and 81.7%, respectively. When a decrease in SGA was used to define a worsening of nutrition, the sensitivity and specificity were 42.3% and 87.0%, respectively.


CONCLUSIONS
Although GNRI is significantly correlated with other nutritional indices, it is not sensitive for screening malnutrition in PD patients. Serial measurements of GNRI are also not sensitive in detecting a change in nutritional status. Further study is needed to identify a simple and reliable tool for the assessment and monitoring of nutritional status in PD patients.
Szeto
Cheuk-Chun
CC
Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong, China. ccszeto@cuhk.edu.hk <ccszeto@cuhk.edu.hk>
Kwan
Bonnie Ching-Ha
BC
Chow
Kai-Ming
KM
Law
Man-Ching
MC
Li
Philip Kam-Tao
PK
D000368:Aged; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D010530:Peritoneal Dialysis; D011502:Protein-Energy Malnutrition / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate