title: Interaction between geriatric nutritional risk index and decoy receptor 3 predicts mortality in chronic hemodialysis patients.
abstract: BACKGROUND
  Protein-energy wasting (PEW) is common and associated with poor outcome in hemodialysis patients. In hemodialysis patients, geriatric nutritional risk index (GNRI) and decoy receptor 3 (DcR3) have been shown as the nutritional and inflammatory markers, respectively. The present study aimed to assess the predictive ability of GNRI and DcR3 for PEW status and long-term outcomes in chronic hemodialysis patients.
  
  
  METHODS
  A prospective cohort of 318 hemodialysis patients was conducted with a median follow-up of 54 months. Malnutrition-inflammation score (MIS) was used as the reference standard for the presence of PEW. Endpoints were cardiovascular and all-cause mortality.
  
  
  RESULTS
  Baseline GNRI had a strong negative correlation with DcR3 and MIS score. For patients with age < or ≥60, high DcR3 and low GNRI were independent predictors for the presence of PEW at baseline. At the end of the study, 81 patients died (27 cardiovascular deaths). The adjusted hazard ratios (95% confidence intervals) of low GNRI and high DcR3 were 1.93 (1.1-4.8) and 2.53 (1.2-5.5) for cardiovascular mortality and 1.85 (1.1-3.2) and 2.37 (1.5-3.7) for all-cause mortality, respectively. While integrated into a model of conventional risk factors, GNRI together with DcR3 further significantly improved the predictability for overall mortality (c statistic, 0.823).
  
  
  CONCLUSIONS
  Low GNRI and high DcR3 were the alternatives for identifying hemodialysis patients at risk of PEW and overall mortality. Further studies are needed to verify whether timely recognition of hemodialysis patients with a high malnutrition-inflammation risk could reduce their mortality by appropriate interventional strategies.
authors.affiliation: Division of Nephrology, Taipei Veterans General Hospital, Taitung Branch, Taitung, Taiwan.
authors.forename: Ming-Tsun
authors.initials: MT
authors.lastname: Tsai
authors.forename: Fen-Hsiang
authors.initials: FH
authors.lastname: Hu
authors.forename: Tse-Jen
authors.initials: TJ
authors.lastname: Lien
authors.forename: Ping-Jen
authors.initials: PJ
authors.lastname: Chen
authors.forename: Tung-Po
authors.initials: TP
authors.lastname: Huang
authors.forename: Der-Cherng
authors.initials: DC
authors.lastname: Tarng
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007249:Inflammation; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D016016:Proportional Hazards Models; D011446:Prospective Studies; D053323:Receptors, Tumor Necrosis Factor, Member 6b / Q000378:metabolism*; D006435:Renal Dialysis / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D053323:Receptors, Tumor Necrosis Factor, Member 6b; C505911:TNFRSF6B protein, human