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. 2023 Sep 1;15(17):3831.
doi: 10.3390/nu15173831.

The Geriatric Nutritional Risk Index Is an Optimal Evaluation Parameter for Predicting Mortality in Adult All Ages Hemodialysis Patients: A Korean Population-Based Study

Do Hyoung Kim  1 , Young-Ki Lee  1 , Hayne Cho Park  1 , Bo Yeon Kim  2 , Miri Lee  3 , Gui Ok Kim  4 , Jinseog Kim  5 , Ajin Cho  1
Affiliations

The Geriatric Nutritional Risk Index Is an Optimal Evaluation Parameter for Predicting Mortality in Adult All Ages Hemodialysis Patients: A Korean Population-Based Study

Do Hyoung Kim et al. Nutrients. .

Abstract

The Geriatric Nutritional Risk Index (GNRI) is a nutritional screening tool used for predicting mortality in patients undergoing hemodialysis (HD). This study investigated the cutoff values for the GNRI for predicting mortality in HD patients using Korean HD quality assessment data from 2015. To identify the optimal GNRI cutoff value, we used Harrell's C-index with multivariate Cox regression models. The highest value of C-index was identified as the cutoff value of GNRI for all-cause mortality in this population. In total, 34,933 patients were included; 90.8 of GNRI was the highest value of C-index, and it was used as a cutoff value to predict mortality; 3311 patients (9.5%) had GNRI values < 90.8, and there were 12,499 deaths during the study period. The mean follow-up period was 53.7 months. The crude mortality rates in patients with GNRI values < 90.8 and ≥ 90.8 were 160.4/1000 and 73.2/1000 person-years respectively. In the fully adjusted Cox model, patients with a GNRI < 90.8 had a 1.78 times higher risk of mortality than those with a GNRI ≥ 90.8. These findings suggest that the optimal GNRI cutoff value is 90.8 for predicting mortality in maintenance HD patients.

Keywords: Geriatric Nutritional Risk Index; cutoff value; end-stage renal disease; hemodialysis; mortality.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the study population.
Figure 2
Figure 2
The C-index of GNRI. The red dot line indicated a GNRI value with the highest C-index.
Figure 3
Figure 3
The relative risk of mortality [HR (95% CI)] with GNRI. Multivariate Model 1 included age, sex, dialysis vintage, and GNRI; Model 2 included the variables of Model 1 plus comorbid conditions; Model 3 (full model) included all previous variables plus laboratory findings.
Figure 4
Figure 4
The C-index of GNRI in subgroups. The red dot line indicated a GNRI value with the highest C-index.
Figure 5
Figure 5
Relative risk of mortality with GNRI in subgroups. Multivariate Model 1 included age, sex, dialysis vintage, and GNRI; Model 2 included the variables of Model 1 plus comorbid conditions; Model 3 (full model) included all previous variables plus laboratory findings.
Figure 6
Figure 6
Survival curves in patients with GNRI < 90.8 vs. GNRI ≥ 90.8.
See this image and copyright information in PMC

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