title: Geriatric nutritional risk index: a mortality predictor in hemodialysis patients.
abstract: Recently, the Geriatric Nutritional Risk Index (GNRI) has been introduced as a valuable tool to assess the nutritional status of hemodialysis (HD) patients. To determine the predictive value of the GNRI score for death in HD, we studied 145 chronic HD patients (%53 men, mean age 60 ± 16 years). The GNRI score was estimated by an equation involving serum albumin and individual's weight and height. According to the highest positive likelihood and risk ratios, the cut-off value of the GNRI for mortality was set at 100. The survival of patients on HD was examined with the Cox proportional hazards model. Mortality was monitored prospectively over an 18-month period, during which 35 patients died. The GNRI (mean 102.6 ± 5.5) was significantly positively correlated with lean body mass, hematocrit, serum lipids and presence of metabolic syndrome. Multivariate Cox proportional hazards analysis demonstrated that the GNRI <100, serum ferritin ≥ 500 μ g/L and age 65 years or older were significant predictors for mortality (hazard ratio 3.691, 95% CI 1.751-7.779, P = 0.001; hazard ratio 3.105, 95% CI 1.536-6.277, P = 0.002; and hazard ratio 2.806, 95% CI 1.297-6.073, P = 0.009, respectively), after adjustment to gender and vintage time. It can be concluded that, in addition to old age, malnutrition (low GNRI) and inflammation (high ferritin) are identified as significant independent risk factors that predict all-cause mortality in HD patients.
authors.affiliation: Department of Nephrology, Arak University of Medical Sciences, Arak, Iran.
authors.forename: Mahnaz
authors.initials: M
authors.lastname: Edalat-Nejad
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Zameni
authors.forename: Mahdi
authors.initials: M
authors.lastname: Qlich-Khani
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Salehi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001827:Body Height; D001834:Body Water; D016009:Chi-Square Distribution; D005260:Female; D005293:Ferritins / Q000097:blood; D015577:Geriatric Assessment; D006801:Humans; D007249:Inflammation / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D024821:Metabolic Syndrome / Q000401:mortality; D008875:Middle Aged; D008954:Models, Biological; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D000075462:Serum Albumin, Human; D013997:Time Factors
chemical_list: C422455:ALB protein, human; D015415:Biomarkers; D012709:Serum Albumin; D005293:Ferritins; D000075462:Serum Albumin, Human