Impact of Annual Change in Geriatric Nutritional Risk Index on Mortality in Patients Undergoing Hemodialysis

Regular nutritional assessment may decrease the mortality rate in patients undergoing hemodialysis. This study aimed to evaluate whether annual change in geriatric nutritional risk index (Delta GNRI) can precisely predict mortality. We retrospectively examined 229 patients undergoing hemodialysis who measured geriatric nutritional risk index (GNRI). Patients were divided into four groups according to the baseline GNRI of 91.2, previously reported cutoff value, and declined or maintained GNRI during the first year (Delta GNRI < 0% vs. Delta GNRI >= 0%): Group 1 (G1), GNRI >= 91.2 and Delta GNRI >= 0%; G2, GNRI >= 91.2 and Delta GNRI < 0%; G3, GNRI < 91.2 and Delta GNRI >= 0%; and G4, GNRI < 91.2 and Delta GNRI < 0%. They were followed for mortality. During a median follow-up of 3.7 (1.9-6.9) years, 74 patients died, of which 35 had cardiovascular-specific causes. The GNRI significantly decreased from 94.8 +/- 6.3 to 94.1 +/- 6.7 in the first year (p = 0.035). Delta GNRI was negatively associated with baseline GNRI (rho = -0.199, p = 0.0051). The baseline GNRI < 91.2 and Delta GNRI < 0% were independently associated with all-cause mortality (adjusted hazard ratio (aHR) 2.59, 95%, confidence interval (CI) 1.54-4.33, and aHR 2.33, 95% CI 1.32-4.32, respectively). The 10-year survival rates were 69.8%, 43.2%, 39.9%, and 19.2% in G1, G2, G3, and G4, respectively (p < 0.0001). The aHR value for G4 vs. G1 was 3.88 (95% CI 1.62-9.48). With regards to model discrimination, adding Delta GNRI to the baseline risk model including the baseline GNRI significantly improved the net reclassification improvement by 0.525 (p = 0.0005). With similar results obtained for cardiovascular mortality. We concluded that the Delta GNRI could not only predict all-cause and cardiovascular mortality but also improve predictability for mortality; therefore, GNRI might be proposed to be serially evaluated.