Abstract: TH-PO913
Comparing the Value of Periodic Assessment of Three Objective Nutrition Scores on the Prognosis of Hemodialysis Patients: A Multicenter Longitudinal Study
Session Information
- Health Maintenance, Nutrition, Metabolism - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Health Maintenance, Nutrition, and Metabolism
- 1500 Health Maintenance, Nutrition, and Metabolism
Authors
- Wang, Qian, The Third Affiliated Hospital of Sun Yat-Sen University Lingnan Hospital, Guangzhou, Guangdong, China
- Ye, Zengchun, The Third Affiliated Hospital of Sun Yat-Sen University Lingnan Hospital, Guangzhou, Guangdong, China
- Peng, Hui, The Third Affiliated Hospital of Sun Yat-Sen University Lingnan Hospital, Guangzhou, Guangdong, China
Background
The prognostic value of objective nutrition scoring tools for longitudinally assessing the relationship between nutritional status and prognosis in hemodialysis patients remains unclear. In this multicenter retrospective cohort study, the prognostic nutritional index (PNI), controlling nutritional states scores (CONUT), and geriatric nutritional risk index (GNRI) were used to longitudinally evaluate nutritional status, and their predictive values for all-cause and cardiovascular mortality were compared.
Methods
Hemodialysis patients from four hospitals were included in the study, and laboratory data and nutrition scores were collected at the start of dialysis, 6 months, 12 months, and 18 months of dialysis. A joint model was used to analyze the relationship between changes in the three nutritional scores and patient prognosis, and area under the curve (AUC) was used to compare their predictive values.
Results
Of the 863 patients included in the study with a median follow-up of 37 months, 23.8% died during follow-up, with 14% being cardiovascular deaths. Malnourished patients had a higher risk for all-cause and cardiovascular mortality. Dynamic changes in PNI and GNRI scores were significantly associated with a reduced risk of all-cause and cardiovascular mortality. Longitudinal increases in PNI and GNRI scores were associated with a 4% and 3% reduction in all-cause(PNI: hazard ratio [HR], 0.96; 95%confidence interval [CI], 0.95-0.98. GNRI: HR, 0.97; 95% CI, 0.96-0.98) and cardiovascular mortality risk(PNI: HR, 0.96; 95% CI, 0.94-0.98. GNRI: HR, 0.97; 95% CI, 0.95-0.98) respectively, with increasing dialysis duration. CONUT score changes were not significantly associated with all-cause death and cardiovascular mortality. The AUC of three joint models showed that GNRI (0.8925)score showed higher predictive accuracy for all-cause than PNI(0.8315) and CONUT(0,852). Similar results were found for the three scores regarding cardiovascular mortality.
Conclusion
Malnutrition strongly associates with increased all-cause and cardiovascular mortality in hemodialysis patients. Regular assessment of nutritional status using GNRI has higher predictive accuracy than CONUT score and PNI score for all-cause and cardiovascular mortality in patients with MHD.