Assessing the Predictive Power of Nutritional Indices on All-Cause and Cardiovascular Mortality in Hemodialysis Patients: A Longitudinal Study

Authors

Qian Wang
Zengchun Ye
Jialing Rao
Wenbo Zhao
Jianqiang Liu
Yanru Chen
Juncheng Xiang
Xin Zhen
Jiawen Li
Yunfang Zhang
Xianrui Dou
Zhaoyong Hu
Jun Zhang
Hui Peng

Publication Date

12-1-2024

Journal

Renal Failure

DOI

10.1080/0886022X.2024.2431140

PMID

39608361

PMCID

PMC11610283

PubMedCentral® Posted Date

11-28-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Humans, Renal Dialysis, Male, Female, Cardiovascular Diseases, Retrospective Studies, Middle Aged, Aged, Nutrition Assessment, Nutritional Status, Longitudinal Studies, Kidney Failure, Chronic, Prognosis, Malnutrition, Cause of Death, Risk Assessment, Risk Factors, Predictive Value of Tests, objective nutritional scores, hemodialysis, mortality, prognostic value

Abstract

BACKGROUND AND HYPOTHESIS: The prognostic value of nutritional scoring tools in assessing the relationship between nutritional status and prognosis in hemodialysis patients is unclear. This multicenter retrospective cohort study compared the Prognostic Nutritional Index (PNI), Controlling Nutritional Status scores (CONUT), and Geriatric Nutritional Risk Index (GNRI) for predictive accuracy of all-cause and cardiovascular mortality, especially the impact of dynamic changes over time on prognosis.

METHODS: Hemodialysis patients from four hospitals were included. Laboratory data and nutrition scores were collected at the initiation of dialysis, and at 6th, 12th, and 18th months after dialysis initiation. A joint model analyzed the relationship between dynamic nutritional scores and prognosis. Predictive values were assessed using the area under the curve (AUC).

RESULTS: The study included 863 patients with a median follow-up of 37 months. During the follow-up, 23.8% of patients died, with 14% attributed to cardiovascular causes. Malnourished patients demonstrated higher risks for all-cause and cardiovascular mortality. Dynamic changes in PNI and GNRI scores were significantly associated with reduced all-cause and cardiovascular mortality risks. Precisely, longitudinal increases in PNI and GNRI scores corresponded to a 4% and 3% reduction in all-cause (PNI: HR, 0.96; 95% 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 longer dialysis duration. Changes in CONUT scores were not significantly associated with either all-cause or cardiovascular mortality. The AUCs of the three joint models indicated that the GNRI score (0.893) possessed higher predictive accuracy for all-cause mortality compared to PNI (0.832) and CONUT (0.852). Similar trends were observed for cardiovascular mortality.

CONCLUSION: Nutritional scores and their dynamic changes are intimately associated with mortality risk in hemodialysis patients. Compared to PNI and CONUT, the baseline GNRI and its post-dialysis variations demonstrate a superior predictive capability for all-cause and cardiovascular mortality in these patients.

Comments

Associated Data