| Objective: To study the correlation between different levels of GNRI(Geriatric nutritional risk index)and death in hemodialysis patients.Methods: Hemodialysis patients who were newly admitted to the hemodialysis center of the First Affiliated Hospital of Nanchang University on May 1,2010 and June30,2019 were divided into four groups by quartering method: group N1,≤85.04;N2group,85.05-91.04,N3 group 91.05-96.49,N4 group ≥96.5.K-M survival curves were used to compare the risk of all-cause mortality and cardiovascular mortality among different GNRI groups,and the N1 group was used as the control group.Cox regression was used to analyze the correlation between GNRI value,all-cause mortality and cardiovascular mortality,and ROC curve was used to observe the predictive value of GNRI on prognosis.Results: A total of 402 hemodialysis patients were included in this study,including 250(62.2%)males and 152(37.8%)females,with an average age of 60.19 ±15 years,102(25.4%)deaths,47(11.7%)cardiovascular deaths and average dialysis age of 33.20±26 months.104 cases(25.8%)were complicated with diabetes and 285 cases(70.9%)with hypertension.The mean value of GNRI was 90.26 ±9.33.The primary diseases were chronic glomerulonephritis in 211 cases(52.8%),diabetic nephropathy in 101 cases(25.1%)and hypertensive nephropathy in 60 cases(14.9%).101 cases in N1 group,100 cases in N2 group,98 cases in N3 group and 103 cases in N4 group.Cardiovascular events occurred in 19(40.4%),7(14.9%),11(23.4%)and 10(21.3%)cases respectively.GNRI levels during the first hemodialysis were 78.13±6.48μmol/L/l,87.95±1.77μmol/L/l,93.80± 1.54μmol/L/l and 101.03± 4.0μmol/L/l,respectively.1.The proportion of dialysis age,total protein,albumin,uric acid,GNRI value and other primary disease in N1 group was lower than that in N2 group(P < 0.05);The proportion of hemoglobin,the proportion of patients complicated with diabetes and the proportion of primary diabetic nephropathy in the N1 group were higher than those in the N2 group(P < 2.0.05).The proportion of dialysis age,total protein,albumin,creatinine,urea,uric acid,GNRI value and other primary disease in N1 group was lower than that in N3 group(P< 0.05);The proportions of total cholesterol and primary disease diabetic nephropathy were higher than those in N3 group(P < 0.05).3.The values of hemoglobin,total protein,albumin,creatinine,urea,uric acid,serum calcium,body weight,diastolic blood pressure and GNRI in group N1 were lower than those in group N4(P < 0.05).The age,the proportion of patients complicated with diabetes and the proportion of primary diabetic nephropathy were higher than those in N4 group(P < 0.05).4.Univariate Cox regression analysis showed patients with advanced age,high total bilirubin,diabetes mellitus had a higher risk of all-cause death.Patients with high albumin,high creatinine,high GNRI,N2 group,N3 group,N4 group had a lower risk of all-cause mortality.5.Multivariate Cox regression analysis showed that,after adjusting for age,creatinine,total bilirubin,uric acid,hemoglobin,total cholesterol,and diabetes,compared with N1 group,N2 group,N3 group and N4 group had a lower risk of allcause mortality.6.Univariate Cox regression analysis showed that Patients with advanced age,high hemoglobin and high cholesterol had a higher risk of cardiovascular death.Whereas Patients with high albumin,high creatinine,high urea,N2 group,N3 group had a lower risk of cardiovascular death.7.Multivariate Cox regression analysis showed that,after adjusting for age,creatinine,urea,hemoglobin,and total cholesterol,compared with N1 group,N2 group,N3 group had a lower risk of cardiovascular events.Conclusions: This study examined the relationship between GNRI and outcome in hemodialysis patients and found that,after adjustment for a variety of risk factors,low GNRI value was strongly associated with the risk of all-cause death and cardiovascular death in hemodialysis patients.The ROC curve found that the GNRI value less than 86.83 had the highest risk of all-cause death. |
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