title: Comparison of Nutritional Risk Scores for Predicting Mortality in Japanese Chronic Hemodialysis Patients.
abstract: Protein energy wasting (PEW) is consistently associated with poor prognosis in hemodialysis (HD) patients. We compared the predictability of PEW as diagnosed by The International Society of Renal Nutrition and Metabolism criteria (PEWISRNM) and geriatric nutritional risk index (GNRI) for all-cause mortality in Japanese HD patients. As cut-off values for body mass index (BMI) for PEW have not been established in PEWISRNMfor Asian populations, these were also investigated.
  
  
  
  The nutritional status from 409 HD patients was evaluated according to ISRNM and GNRI criteria. To compare the predictability of mortality, C-index, net reclassification improvement (NRI) and integrated discrimination improvement were evaluated.
  
  
  
  During follow-up (median, 52 months; range, 7 months), 70 patients (17.1%) presented PEW according to ISRNM and 131 patients (32.1%) according to GNRI; in addition, 101 patients (24.7%) died. PEWISRNMand GNRI were identified as independent predictors of death. Addition of PEWISRNMand GNRI to a predictive model based on established risk factors improved NRI and integrated discrimination improvement. However, no differences were found between models including PEWISRNMand GNRI. When lowering the criterion level of BMI per 1 kg/m2sequentially, PEWISRNMat BMI <20 kg/m2maximized the hazard ratio for mortality. The model including PEWISRNMat BMI <20 kg/m2improved NRI compared with the model including GNRI.
  
  
  
  PEWISRNMand GNRI represent independent predictors of mortality, with comparable predictability. The diagnostic criterion of BMI in the ISRNM for Japanese population might be better at <20 kg/m2than at <23 kg/m2.
authors.affiliation: Department of Nephrology, School of Medicine, Fujita Health University, Toyoake, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Department of Nutrition, Faculty of Wellness, Shigakkan University, Obu, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Inoue
authors.affiliation: Department of Nutrition, Hakuyokai Hospital, Nagoya, Japan.
authors.forename: Kazue
authors.initials: K
authors.lastname: Shimizu
authors.affiliation: Department of Nutrition, Shinseikai-Daiichi Hospital, Nagoya, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Hiraga
authors.affiliation: Department of Nutrition, Kaikokai-Central Clinic, Nagoya, Japan.
authors.forename: Erika
authors.initials: E
authors.lastname: Takahashi
authors.affiliation: Department of Nutrition, Daiyukai Daiichi Hospital, Ichinomiya, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Otaki
authors.affiliation: Department of Nutrition, Medical Satellite Nagoya, Nagoya, Japan.
authors.forename: Taeko
authors.initials: T
authors.lastname: Yoshikawa
authors.affiliation: Department of Nutrition, Tajimi Clinic, Tajimi, Japan.
authors.forename: Kumiko
authors.initials: K
authors.lastname: Furuta
authors.affiliation: Department of Nutrition, Suzuka Kidney Clinic, Suzuka, Japan.
authors.forename: Chika
authors.initials: C
authors.lastname: Tokunaga
authors.affiliation: Department of Nutrition, Kaikokai-Central Clinic, Nagoya, Japan.
authors.forename: Tomoyo
authors.initials: T
authors.lastname: Sakakibara
authors.affiliation: Department of Nephrology and Renal Replacement Therapy, Graduate School of Medicine, Nagoya University, Nagoya, Japan. Electronic address: yasuito@med.nagoya-u.ac.jp.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Ito
mesh_terms: D000368:Aged; D044466:Asian People; D015992:Body Mass Index; D004032:Diet; D004044:Dietary Proteins / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D007564:Japan; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D011379:Prognosis; D016016:Proportional Hazards Models; D011502:Protein-Energy Malnutrition / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism
chemical_list: D004044:Dietary Proteins; D012709:Serum Albumin