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Abstract: PO1214

Association of Geriatric Nutritional Risk Index with Decline in Residual Kidney Function in Incident Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kimura, Hiroshi, 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
  • Rhee, Connie, 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
  • 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 is highly prevalent and is a significant contributor to adverse outcomes among hemodialysis patients. Residual kidney function (RKF) provides effective and continuous clearance of both small and middle molecules, plays an important role in nutritional status. However, the impact of malnutrition on the decline of RKF has not been well studied. The objective of this study was to investigate the association of baseline Geriatric Nutritional Risk Index (GNRI) with a decline in RKF over 1 year after dialysis initiation among hemodialysis patients.

Methods

We included 6,649 hemodialysis patients who initiated dialysis treatment in a large United States dialysis organization between January 1, 2007, and December 31, 2011. Rapid decline in RKF was defined as the percent change in residual urea creatinine (KRU) greater than 50% per year. The associations of GNRI with decline in RKF were retrospectively examined across three strata of GNRI [ low (GNRI <92), middle (GNRI 92-98), high (GNRI >98) GNRI group] using logistic regression models adjusted for clinical characteristics and laboratory valuables. Then, we used the linear mixed-effects model allowing for a random intercept and slope using unstructured covariance matrices to estimate the magnitude and decline of RKF over 1 year according to the GNRI groups

Results

The median GNRI and baseline KRU were 107.7 and 3.4 ml/min/1.73m2, respectively. Lower GNRI was associated with a smaller proportion of diabetes, lower baseline KRU, BMI, nPCR, and serum albumin. Adjusting for patient’s differences, there was an inverse relationship between lower GNRI and a higher odds of rapid decline in RKF [adjusted odds ratio: 1.97 (1.61–2.41) and 1.48 (1.25-1.76) for low and middle GNRI groups, (reference: high GNRI group]. KRU trajectories showed greater KRU decline over time in lower GNRI.

Conclusion

Lower GNRI was associated with a rapid decline in RKF, especially in the first 3 months after transitioning to hemodialysis.