title: Geriatric Nutritional Risk Index, a simplified nutritional screening index, is a significant predictor of mortality in chronic dialysis patients.
abstract: BACKGROUND
  Malnutrition is a common complication in haemodialysis patients. Recently, the Geriatric Nutritional Risk Index (GNRI) has been reported as a simple and accurate tool to assess nutritional status of haemodialysis patients. Our objective was to examine the association between GNRI and mortality in chronic haemodialysis patients.
  
  
  METHODS
  We examined the GNRI of 490 maintenance haemodialysis patients (60 ± 12 years, 293 males and 197 females) and followed up these patients for 60 months. Predictors for all-cause death were examined using Kaplan-Meier analysis and Cox proportional analyses.
  
  
  RESULTS
  The GNRI was 98.0 ± 6.0, and was significantly and negatively correlated with age and haemodialysis duration. During the 60-month follow-up period, 129 patients died. According to the highest positive likelihood and risk ratios, the cutoff value of GNRI for mortality was set at 90. Kaplan-Meier analysis revealed that patients with a GNRI <90 (n = 50) had a significantly lower survival rate, compared to those with GNRI ≥90 (n = 440) (log-rank test, P < 0.0001). Multivariate Cox proportional hazards analyses demonstrated that GNRI was a significant predictor for mortality [hazard ratio (HR) 0.962, 95% confidence interval (CI) 0.931-0.995, P < 0.05], after adjustment for age, gender, C-reactive protein, presence of diabetes and haemodialysis duration.
  
  
  CONCLUSIONS
  These results demonstrated that GNRI is a significant predictor for mortality in haemodialysis patients. The simple method of GNRI is considered to be a clinically useful marker for the assessment of nutritional status in haemodialysis patients.
authors.affiliation: Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Ikue
authors.initials: I
authors.lastname: Kobayashi
authors.forename: Eiji
authors.initials: E
authors.lastname: Ishimura
authors.forename: Yoko
authors.initials: Y
authors.lastname: Kato
authors.forename: Senji
authors.initials: S
authors.lastname: Okuno
authors.forename: Tadashi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yamakawa
authors.forename: Katsuhito
authors.initials: K
authors.lastname: Mori
authors.forename: Masaaki
authors.initials: M
authors.lastname: Inaba
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Nishizawa
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D044342:Malnutrition / Q000175:diagnosis; D008875:Middle Aged; D009752:Nutritional Status; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality*; D015996:Survival Rate