The impact of malnutritional status on survival in elderly hemodialysis patients

Background: The number of geriatric patients with end-stage renal disease undergoing maintenance hemodialysis has increased in Taiwan. However, protein-energy wasting is prevalent and associated with poor outcome in this patient population. It is generally well-known that geriatric nutritional risk index (GNRI) is a good survival predictor in general elderly patients. However, the association of GNRI with mortality in geriatric end-stage renal disease patients remains unclear. The present study aimed to assess the predictive ability of GNRI for overall mortality in elderly hemodialysis patients. Methods: GNRI was measured in a cohort of 104 hemodialysis patients aged >= 65 years. Thereafter, these patients were followed for a median period of 38.5 months. For all cases, all-cause mortality was the primary endpoint. Results: Patients with baseline GNRI <92 had significantly lower body weight, body mass index, serum albumin, and hemoglobin level, but were administered a higher erythropoietin dose as compared to those with GNRI >= 92. Basal GNRI independently correlated with erythropoietin resistance index (beta = -1.97, p < 0.001) and serum high-sensitivity C-reactive protein (beta= -0.71, p = 0.021). By the conclusion of the study, 45 patients had died. High GNRI was associated with the lower risk of mortality after adjustment for other potential confounders [hazard ratio = 0.41; 95% confidence interval (CI) = 0.22-0.90; p = 0.005]. Conclusion: GNRI is a significant predictor for mortality in elderly hemodialysis patients, and may be adopted to improve assessment of the malnutrition inflammation status. Copyright (C) 2016, the Chinese Medical Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license