目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者老年营养风险指数(geriatric nutritional risk index,GNRI)与临床指标的相关性。 方法 本研究为多中心横断面研究。纳入2019～2020年安徽省宣城市人民医院血液净化中心等29家透析中心2678例MHD患者，收集相关人口学特征、原发病、实验室检查等资料，其中依据白蛋白、身高、体质量等计算老年营养风险指数值，根据老年营养风险指数值分为高营养风险组(GNRI＜82)，中营养风险组(82≤GNRI＜92)，低营养风险组(92≤GNRI≤98)，无营养风险组(GNRI＞98)，单因素方差分析4组间临床指标的差异，多元线性回归分析老年营养风险指数与临床指标的相关性。 结果 MHD患者中存在营养风险的占40.3%(1084/2687)，高、中、低营养风险占比分别为3.0%、13.5%和23.7%；Pearson相关分析发现年龄(r=-0.101，P＜0.001)、超敏C反应蛋白(r =-0.195，P =0.002)与GNRI呈负相关，血红蛋白(r=0.266，P＜0.001)、肌酐(r=0.225，P＜0.001)、三酰甘油(r =0.147，P＜0.001)、低密度脂蛋白(r=0.089，P＜0.001)、胆固醇(r=0.060，P =0.002)、血镁(r=0.113，P＜0.001)、血磷(r=0.127，P＜0.001)、甲状旁腺激素(r=0.051，P =0.008)与GNRI呈正相关。多元线性回归分析发现MHD患者GNRI与血清肌酐(β=0.070，P＜0.001)、三酰甘油(β=0.070，P＜0.001)、低密度脂蛋白(β=0.034，P=0.009)独立相关。 结论 维持性血液透析患者营养风险比例高，老年营养风险指数是反映血液透析患者营养状态的有用指标。
汪炜
,
石瑞
,
李秀勇
,
白友为
,
刘智
,
梁绍钦
,
陈雷
,
唐晓飞
,
李激
,
郭玉文
,
袁亮
,
王德光
. 维持性血液透析患者老年营养风险指数与临床指标的相关性分析[J]. 中国血液净化, 2023
, 22(02)
: 90
-94
.
DOI: 10.3969/j.issn.1671-4091.2023.02.003
Objective To evaluate the associated between Geriatric Nutritional Risk Index (GNRI) and clinical characteristics in maintenance hemodialysis (MHD) patients. Methods Two thousand six hundred and seventy-eight patients in MHD were recruited. Clinical characteristics of the patients were collected. We divided patients into the highest GNRI group (>98), considered to have no risk of malnutrition, the high GNRI group (92≤GNRI≤98), considered to have a low risk of malnutrition, median GNRI group (82≤GNRI＜92), considered to have a median risk of malnutrition, and low GNRI group (＜82), considered to have a high risk of malnutrition. Pearson correlation analyses and multiple linear regression analyses were conducted. Results One thousand and eighty-four patients (40.3%) were at risk of malnutrition. Pearson analysis showed that age (r=-0.101, P＜0.001) and hypersensitive c reactive protein (hsCRP) (r=-0.195, P=0.002) were negatively correlated with GNRI. Hemoglobin (r=0.266, P＜0.001), serum creatinine (r=0.225, P＜0.001), triglyceride (r=0.147, P＜0.001), low density lipoprotein (r=0.089, P＜0.001), cholesterol (r=0.060, P=0.002), serum magnesium (r=0.113, P＜0.001), serum phosphorus (r=0.127, P＜0.001), parathyroid hormone (r=0.051, P=0.008) were positively correlated with GNRI. Multivariate logistic regression analysis shown that serum creatinine (β=0.070, P＜0.001), triglyceride (β=0.070, P＜0.001) and low density lipoprotein (β=0.034, P=0.009) were significantly associated with GNRI. Conclusions GNRI may be a reasonable indicator for assessment and monitoring of nutritional status in MHD patients.
[1] Sahathevan S, Khor B, Ng H, et al. Understanding Development of Malnutrition in Hemodialysis Patients: A Narrative Review[J]. Nutrients,2020,12(10):3147.
[2] Kopple J D. National Kidney Foundation K/DOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure[J]. American Journal of Kidney Diseases,2001,37(1):S66-S70.
[3] Bouillanne O M G D C. Geriatric nutritional risk index: a new index for evaluating at-risk elderly medical patients.[J]. Am J Clin Nutr,2005,82:777-783.
[4] Matsukuma Y, Tanaka S, Taniguchi M, et al. Association of geriatric nutritional risk index with infection-related mortality in patients undergoing hemodialysis: The Q-Cohort Study[J]. Clinical Nutrition,2019,38(1):279-287.
[5] Hwang W, Cho M S, Oh J E, et al. Comparison of creatinine index and geriatric nutritional risk index for nutritional evaluation of patients with hemodialysis[J]. Hemodialysis International,2018,22(4):507-514.
[6] Yamada S, Yamamoto S, Fukuma S, et al. Geriatric Nutritional Risk Index (GNRI) and Creatinine Index Equally Predict the Risk of Mortality in Hemodialysis Patients: J-DOPPS[J]. Scientific Reports,2020,10(1).
[7] Canaud B, Granger V A, Molinari N, et al. Creatinine index as a surrogate of lean body mass derived from urea Kt/V, pre-dialysis serum levels and anthropometric characteristics of haemodialysis patients[J]. PLoS One,2014,9(3):e93286.
[8] Yoshida M, Nakashima A, Doi S, et al. Lower Geriatric Nutritional Risk Index (GNRI) Is Associated with Higher Risk of Fractures in Patients Undergoing Hemodialysis[J]. Nutrients,2021,13(8):2847.
[9] El Ati Z, Machfar H, Boussafa H, et al. Metabolic syndrome, malnutrition, and its associations with cardiovascular and all-cause mortality in hemodialysis patients: Follow-up for three years[J]. Saudi journal of kidney diseases and transplantation,2020,31(1):129-135.
[10] Choi S R, Lee Y, Cho A J, et al. Malnutrition, inflammation, progression of vascular calcification and survival: Inter-relationships in hemodialysis patients[J]. PLOS ONE,2019,14(5):e216415.
[11] Borges M C C, Vogt B P, Martin L C, et al. Malnutrition Inflammation Score cut-off predicting mortality in maintenance hemodialysis patients[J]. Clinical Nutrition ESPEN,2017,17:63-67.
[12] Rosenberger J, Kissova V, Majernikova M, et al. Body Composition Monitor Assessing Malnutrition in the Hemodialysis Population Independently Predicts Mortality[J]. Journal of Renal Nutrition,2014,24(3):172-176.
[13] Carrero J J, Thomas F, Nagy K, et al. Global Prevalence of Protein-Energy Wasting in Kidney Disease: A Meta-analysis of Contemporary Observational Studies From the International Society of Renal Nutrition and Metabolism[J]. Journal of Renal Nutrition,2018,28(6):380-392.
[14] 张思涵. GNRI与血液透析患者死亡的相关性[D]. 南昌大学,2021.
[15] Kobayashi I, Ishimura E, Kato Y, et al. Geriatric Nutritional Risk Index, a simplified nutritional screening index, is a significant predictor of mortality in chronic dialysis patients[J]. Nephrology Dialysis Transplantation,2010,25(10):3361-3365.
[16] Iseki K, Yamazato M, Tozawa M, et al. Hypocholesterolemia is a significant predictor of death in a cohort of chronic hemodialysis patients[J]. Kidney International,2002,61(5):1887-1893.
[17] Liu Y, Coresh J, Eustace J A. Association between cholesterol level and mortality in dialysis patients[J]. ACC Current Journal Review,2004,13(4):10-11.
[18] 李莹莹，邢广群，李靖. 尿毒症患者异常升高的甲状旁腺激素水平与营养和衰弱状态的关系研究[J]. 中国血液净化,2021,20(9):608-611.
[19] 苏凤籼，吴静，周朝敏，等. 低甲状旁腺素血症与透析患者蛋白质能量消耗的相关性[J]. 中华医学杂志,2018(42):3401-3405.
[20] Ribeiro M C C B, Vogt B P, Vannini F C D, et al. Role of parathyroid hormone in anorexia on maintenance hemodialysis patients[J]. Clinical Nutrition ESPEN,2019,34:137-141.
[21] Yajima T, Yajima K, Takahashi H. Impact of Annual Change in Geriatric Nutritional Risk Index on Mortality in Patients Undergoing Hemodialysis[J]. Nutrients,2020,12(11):3333.
[22] Beberashvili I, Azar A, Sinuani I, et al. Geriatric nutritional risk index, muscle function, quality of life and clinical outcome in hemodialysis patients[J]. Clinical Nutrition,2016,35(6):1522-1529.
