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Kidney Week

Abstract: PO1215

Prognostic Nutritional Index and Mortality Among Maintenance Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Miyasato, Yoshikazu, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Wenziger, Cachet, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Hsiung, Jui-Ting, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Rhee, Connie, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Kovesdy, Csaba P., The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
Background

Malnutrition and inflammation are associated with the mortality of dialysis patients. Prognostic Nutritional Index (PNI), which is composed of serum albumin levels and total lymphocyte count, has been suggested as a simple and useful prognostic marker in postoperative cancer patients. We evaluated the usefulness of PNI for predicting mortality in hemodialysis patients.

Methods

This retrospective cohort study included the patients who started hemodialysis in a large U.S. dialysis organization from 2007 to 2011. We examined the association between the quartiles of PNI and mortality using Cox regression model. Besides, we compared the mortality predictability of PNI and its components (serum albumin levels and total lymphocyte count) using the receiver operating characteristic curve (AUROC), net reclassification improvement (NRI) and integrated discrimination improvement (IDI).

Results

The mean age (and standard deviation) of total 101,616 patients was 63±15 years, and 26,622 died during the median follow-up period of 1.4 years. Higher quartiles of PNI were associated with lower mortality; case-mix adjusted hazard ratios (95%CI) were 0.66 (0.64-0.68), 0.49 (0.48-0.51), 0.35 (0.34-0.37) among patients with PNI 39.5-<43.1, 43.1-<46.6, and 46.6-< (reference: PNI <39.5). PNI showed higher mortality predictability than serum albumin levels and total lymphocyte count; AUROC (95%CI); 0.746 (0.742-0.750), 0.743 (0.739-0.748), 0.711 (0.706-0.716), NRI (95%CI); 0.436 (0.418-0.454), 0.410 (0.392-0.429), 0.174 (0.156-0.192), IDI (95%CI);0.034 (0.032-0.035), 0.032 (0.030-0.033), 0.003 (0.003-0.004), respectively. The difference in the AUROC was statistically significant between PNI and its components. In subgroup analysis PNI well predicted mortality in younger than 75 year-old patients.

Conclusion

Higher PNI was associated with lower mortality in hemodialysis patients. Compared with serum albumin levels and total lymphocyte count, PNI seems to be a useful predicting marker of mortality.

Figure: Mortality risk associated with PNI