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Abstract: PO1054

Combined Value of Geriatric Nutritional Risk Index, Body Composition, and Bone Mineral Density for Predicting Mortality of Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Mizuiri, Sonoo, Ichiyokai Harada Hospital, Hiroshima, Japan
  • Nishizawa, Yoshiko, Ichiyokai Harada Hospital, Hiroshima, Japan
  • Doi, Toshiki, Hiroshima University Hospital, Hiroshima, Japan
  • Yamashita, Kazuomi, Ichiyokai Harada Hospital, Hiroshima, Japan
  • Shigemoto, Kenichiro, Ichiyokai Harada Hospital, Hiroshima, Japan
  • Doi, Shigehiro, Hiroshima University Hospital, Hiroshima, Japan
  • Masaki, Takao, Hiroshima University Hospital, Hiroshima, Japan

Group or Team Name

  • Hiroshima University
Background

Prognostic utility of the geriatric nutritional risk index (GNRI) and the association between body mass index and bone mineral density (BMD) in hemodialysis (HD) patients are uncertain. We assessed the combined predictive value of GNRI, body composition, and BMD in HD patients.

Methods

Pre-dialysis laboratory data, same-day post-dialysis body composition parameters by the Body Composition Monitor (Fresenius), and radius, lumbar spine, and femoral bone mineral density (BMD) using dual energy X-ray absorptiometry were assessed in HD patients at baseline. The data were compared according to GNRI tertiles (T). Logistic regression analysis was used to assess GNRI T1. Kaplan-Meier survival and Cox proportional hazard analyses were conducted. Comparison of multiple receiver operating characteristic curves was performed to assess whether mortality prediction accuracy improved after adding GNRI, body composition, and BMD to established risk factors.

Results

Among 264 patients (male: 65%, diabetes: 42%), mean age was 65±12 years and the median dialysis vintage was 79 (39–144) months. GNR T1, T2, T3 were 88 (85–91), 94 (93–95), 98 (97–101), respectively. GNRI T1 patients showed older age, lower male frequency, and lower serum albumin, body cell mass index (BCMI), lean tissue index, fat tissue index (FTI), lumbar spine, femoral neck, and right distal mid-third radius BMD, but higher overhydration/extracellular fluid than patients with GNRI T2 or T3 (P<0.05). FTI (OR: 0.88), femoral neck BMD (OR: 0.05), age (OR: 1.03), C-reactive protein (OR: 1.37) and hemoglobin (OR: 0.70) were significant predictors of GNRI T1 (P<0.05). Patients with GNRI T1 showed significantly lower 2-year survival and GNRI T was significant predictor for 2-year all-cause mortality [Hazard ratio (T1-2): 2.07 (0.56-9.83), (T1-3): 8.59e+9 (2.45-3.39e+37), P<0.05]. Area-under-the curve for all-cause mortality using established risk factors (age, sex, diabetes, serum phosphate) was 0.66, improving to 0.79 by adding GNRI alone or to 0.81 by adding GNRI, FTI, and femoral neck BMD (P<0.05).

Conclusion

Associations of GNRI, body composition, and BMD were confirmed in HD patients. Combining GNRI, body composition, and BMD to established risk factors improved mortality prediction in HD patients.

Funding

  • Private Foundation Support