Assessing the predictive power of nutritional indices on all-cause and cardiovascular mortality in hemodialysis patients: a longitudinal study

Ren Fail. 2024 Dec;46(2):2431140. doi: 10.1080/0886022X.2024.2431140. Epub 2024 Nov 28.

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.

Keywords: hemodialysis; mortality; objective nutritional scores; prognostic value.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Cardiovascular Diseases* / etiology
  • Cardiovascular Diseases* / mortality
  • Cause of Death
  • Female
  • Humans
  • Kidney Failure, Chronic* / complications
  • Kidney Failure, Chronic* / mortality
  • Kidney Failure, Chronic* / therapy
  • Longitudinal Studies
  • Male
  • Malnutrition / diagnosis
  • Malnutrition / etiology
  • Malnutrition / mortality
  • Middle Aged
  • Nutrition Assessment*
  • Nutritional Status*
  • Predictive Value of Tests
  • Prognosis
  • Renal Dialysis* / mortality
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors

Grants and funding

This work was supported by the Natural Science Foundation of Guangdong, China (2022A1515012637 to HP), Guangdong Provincial Enterprise Joint Fund for Basic and Applied Basic Research - Key Project (2021B1515230005 to HP), Guangzhou Science and Technology Project (201807010037 to HP), and the Three Big Construction of Large Science Program of Sun Yat-sen University (82000-18843406 and 82000-18833404 to HP).