title: The impact of malnutritional status on survival in elderly hemodialysis patients.
abstract: BACKGROUND
  The number of geriatric patients with end-stage renal disease undergoing maintenance hemodialysis has increased in Taiwan. However, protein-energy wasting is prevalent and associated with poor outcome in this patient population. It is generally well-known that geriatric nutritional risk index (GNRI) is a good survival predictor in general elderly patients. However, the association of GNRI with mortality in geriatric end-stage renal disease patients remains unclear. The present study aimed to assess the predictive ability of GNRI for overall mortality in elderly hemodialysis patients.
  
  
  METHODS
  GNRI was measured in a cohort of 104 hemodialysis patients aged ≥65 years. Thereafter, these patients were followed for a median period of 38.5 months. For all cases, all-cause mortality was the primary endpoint.
  
  
  RESULTS
  Patients with baseline GNRI <92 had significantly lower body weight, body mass index, serum albumin, and hemoglobin level, but were administered a higher erythropoietin dose as compared to those with GNRI ≥92. Basal GNRI independently correlated with erythropoietin resistance index (β = -1.97, p < 0.001) and serum high-sensitivity C-reactive protein (β = -0.71, p = 0.021). By the conclusion of the study, 45 patients had died. High GNRI was associated with the lower risk of mortality after adjustment for other potential confounders [hazard ratio = 0.41; 95% confidence interval (CI) = 0.22-0.90; p = 0.005].
  
  
  CONCLUSIONS
  GNRI is a significant predictor for mortality in elderly hemodialysis patients, and may be adopted to improve assessment of the malnutrition-inflammation status.
authors.affiliation: Division of Nephrology, Department of Medicine, Wei Gong Memorial Hospital, Miaoli, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Ming-Tsun
authors.initials: MT
authors.lastname: Tsai
authors.affiliation: Division of Nephrology, Department of Medicine, Wei Gong Memorial Hospital, Miaoli, Taiwan, ROC.
authors.forename: Hsiang-Chung
authors.initials: HC
authors.lastname: Liu
authors.affiliation: Division of Nephrology, Department of Medicine, Wei Gong Memorial Hospital, Miaoli, Taiwan, ROC. Electronic address: tphuang0508@gmail.com.
authors.forename: Tung-Po
authors.initials: TP
authors.lastname: Huang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000401:mortality; D008297:Male; D044342:Malnutrition / Q000150:complications*; D009752:Nutritional Status; D016016:Proportional Hazards Models; D011502:Protein-Energy Malnutrition / Q000150:complications; D006435:Renal Dialysis / Q000401:mortality*
keywords: elderly; geriatric nutritional risk index; hemodialysis; mortality