Impact of the geriatric nutritional risk index on long-term outcomes in patients undergoing hemodialysis: a meta-analysis of observational studies
BackgroundThis meta-analysis aimed to synthesize current evidence on the association between the Geriatric Nutritional Risk Index (GNRI) and long-term outcomes in patients undergoing hemodialysis.MethodsElectronic databases were systematically searched for relevant studies that investigated the asso...
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| Format: | Article |
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Frontiers Media S.A.
2024-03-01
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| Series: | Frontiers in Nutrition |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnut.2024.1346870/full |
| _version_ | 1797254069578891264 |
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| author | Kuo-Chuan Hung Chia-Li Kao Chih-Wei Hsu Chia-Hung Yu Chien-Ming Lin Hsiao-Tien Chen Ying-Jen Chang Shu-Wei Liao I-Wen Chen |
| author_facet | Kuo-Chuan Hung Chia-Li Kao Chih-Wei Hsu Chia-Hung Yu Chien-Ming Lin Hsiao-Tien Chen Ying-Jen Chang Shu-Wei Liao I-Wen Chen |
| author_sort | Kuo-Chuan Hung |
| collection | DOAJ |
| description | BackgroundThis meta-analysis aimed to synthesize current evidence on the association between the Geriatric Nutritional Risk Index (GNRI) and long-term outcomes in patients undergoing hemodialysis.MethodsElectronic databases were systematically searched for relevant studies that investigated the association between GNRI and long-term outcomes in hemodialysis patients until November 2023. The primary outcome was the association between the GNRI (i.e., low versus high) and overall mortality risk, while the secondary outcome was the relationship between the GNRI and cardiovascular mortality risk.ResultsThirty cohort studies involving 55,864 patients were included. A low GNRI was found to be significantly associated with increased overall mortality (hazard ratio [HR]: 2.42, 95% confidence interval [CIs]: 2.10–2.79, p < 0.00001, I2 = 65%). Each unit increase in GNRI corresponded to a 5% reduction in mortality risk (HR: 0.95, 95% CI: 0.93–0.96, p < 0.00001, I2 = 79%). The association remained consistent across Asian (HR = 2.45, 95% CI: 2.08–2.88, p < 0.00001, I2 = 70%) and non-Asian subgroups (HR = 2.3, 95% CI: 1.72–3.06, p < 0.00001, I2 = 23%). Meta-regression analysis of patient age (coefficient: −0.002; p = 0.896), male proportion (coefficient: 0.002; p = 0.875), percentage of diabetes mellitus (coefficient: −0.003; p = 0.605), and follow-up duration (coefficient: −0.003; p = 0.431) revealed that these moderator variables did not significantly influence the association between GNRI and overall mortality risk. Cardiovascular mortality risk also increased with low GNRI (HR, 1.93; 95%CI: 1.51–2.45, p < 0.00001; I2 = 2%). Similarly, an inverse association was observed between the GNRI values and cardiovascular mortality risk (HR, 0.94; 95% CI: 0.91–0.97; p < 0.0001; I2 = 65%) (per unit increase).ConclusionThe GNRI is a simple nutritional screening tool that can be used to effectively stratify patients undergoing hemodialysis globally. Further studies are warranted to determine whether nutrition optimization based on the GNRI improves long-term outcomes.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, CRD42023483729. |
| first_indexed | 2024-04-24T21:44:06Z |
| format | Article |
| id | doaj.art-cc865b07b6fd4ecf889d7d5c5419b8f5 |
| institution | Directory Open Access Journal |
| issn | 2296-861X |
| language | English |
| last_indexed | 2024-04-24T21:44:06Z |
| publishDate | 2024-03-01 |
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| series | Frontiers in Nutrition |
| spelling | doaj.art-cc865b07b6fd4ecf889d7d5c5419b8f52024-03-21T04:31:53ZengFrontiers Media S.A.Frontiers in Nutrition2296-861X2024-03-011110.3389/fnut.2024.13468701346870Impact of the geriatric nutritional risk index on long-term outcomes in patients undergoing hemodialysis: a meta-analysis of observational studiesKuo-Chuan Hung0Chia-Li Kao1Chih-Wei Hsu2Chia-Hung Yu3Chien-Ming Lin4Hsiao-Tien Chen5Ying-Jen Chang6Shu-Wei Liao7I-Wen Chen8Department of Anesthesiology, Chi Mei Medical Center, Tainan, TaiwanDepartment of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung, TaiwanDepartment of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, TaiwanDepartment of Anesthesiology, Chi Mei Medical Center, Tainan, TaiwanDepartment of Anesthesiology, Chi Mei Medical Center, Tainan, TaiwanDepartment of Chinese Medicine, Chi Mei Medical Center, Tainan, TaiwanDepartment of Anesthesiology, Chi Mei Medical Center, Tainan, TaiwanDepartment of Anesthesiology, Chi Mei Medical Center, Tainan, TaiwanDepartment of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan, TaiwanBackgroundThis meta-analysis aimed to synthesize current evidence on the association between the Geriatric Nutritional Risk Index (GNRI) and long-term outcomes in patients undergoing hemodialysis.MethodsElectronic databases were systematically searched for relevant studies that investigated the association between GNRI and long-term outcomes in hemodialysis patients until November 2023. The primary outcome was the association between the GNRI (i.e., low versus high) and overall mortality risk, while the secondary outcome was the relationship between the GNRI and cardiovascular mortality risk.ResultsThirty cohort studies involving 55,864 patients were included. A low GNRI was found to be significantly associated with increased overall mortality (hazard ratio [HR]: 2.42, 95% confidence interval [CIs]: 2.10–2.79, p < 0.00001, I2 = 65%). Each unit increase in GNRI corresponded to a 5% reduction in mortality risk (HR: 0.95, 95% CI: 0.93–0.96, p < 0.00001, I2 = 79%). The association remained consistent across Asian (HR = 2.45, 95% CI: 2.08–2.88, p < 0.00001, I2 = 70%) and non-Asian subgroups (HR = 2.3, 95% CI: 1.72–3.06, p < 0.00001, I2 = 23%). Meta-regression analysis of patient age (coefficient: −0.002; p = 0.896), male proportion (coefficient: 0.002; p = 0.875), percentage of diabetes mellitus (coefficient: −0.003; p = 0.605), and follow-up duration (coefficient: −0.003; p = 0.431) revealed that these moderator variables did not significantly influence the association between GNRI and overall mortality risk. Cardiovascular mortality risk also increased with low GNRI (HR, 1.93; 95%CI: 1.51–2.45, p < 0.00001; I2 = 2%). Similarly, an inverse association was observed between the GNRI values and cardiovascular mortality risk (HR, 0.94; 95% CI: 0.91–0.97; p < 0.0001; I2 = 65%) (per unit increase).ConclusionThe GNRI is a simple nutritional screening tool that can be used to effectively stratify patients undergoing hemodialysis globally. Further studies are warranted to determine whether nutrition optimization based on the GNRI improves long-term outcomes.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, CRD42023483729.https://www.frontiersin.org/articles/10.3389/fnut.2024.1346870/fullgeriatric nutritional risk indexhemodialysisoverall mortalitymeta-analysisrenal failure |
| spellingShingle | Kuo-Chuan Hung Chia-Li Kao Chih-Wei Hsu Chia-Hung Yu Chien-Ming Lin Hsiao-Tien Chen Ying-Jen Chang Shu-Wei Liao I-Wen Chen Impact of the geriatric nutritional risk index on long-term outcomes in patients undergoing hemodialysis: a meta-analysis of observational studies Frontiers in Nutrition geriatric nutritional risk index hemodialysis overall mortality meta-analysis renal failure |
| title | Impact of the geriatric nutritional risk index on long-term outcomes in patients undergoing hemodialysis: a meta-analysis of observational studies |
| title_full | Impact of the geriatric nutritional risk index on long-term outcomes in patients undergoing hemodialysis: a meta-analysis of observational studies |
| title_fullStr | Impact of the geriatric nutritional risk index on long-term outcomes in patients undergoing hemodialysis: a meta-analysis of observational studies |
| title_full_unstemmed | Impact of the geriatric nutritional risk index on long-term outcomes in patients undergoing hemodialysis: a meta-analysis of observational studies |
| title_short | Impact of the geriatric nutritional risk index on long-term outcomes in patients undergoing hemodialysis: a meta-analysis of observational studies |
| title_sort | impact of the geriatric nutritional risk index on long term outcomes in patients undergoing hemodialysis a meta analysis of observational studies |
| topic | geriatric nutritional risk index hemodialysis overall mortality meta-analysis renal failure |
| url | https://www.frontiersin.org/articles/10.3389/fnut.2024.1346870/full |
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