Lower Geriatric Nutritional Risk Index (<i>GNRI</i>) Is Associated with Higher Risk of Fractures in Patients Undergoing Hemodialysis
Background: Although malnutrition and bone fracture are both major complications in patients undergoing hemodialysis, their association has not been clarified. The aim of our study was to clarify the association between the geriatric nutritional risk index (<i>GNRI</i>), an indicator of...
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MDPI AG
2021-08-01
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| Series: | Nutrients |
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| Online Access: | https://www.mdpi.com/2072-6643/13/8/2847 |
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| author | Maria Yoshida Ayumu Nakashima Shigehiro Doi Kazuya Maeda Naoki Ishiuchi Takayuki Naito Takao Masaki |
| author_facet | Maria Yoshida Ayumu Nakashima Shigehiro Doi Kazuya Maeda Naoki Ishiuchi Takayuki Naito Takao Masaki |
| author_sort | Maria Yoshida |
| collection | DOAJ |
| description | Background: Although malnutrition and bone fracture are both major complications in patients undergoing hemodialysis, their association has not been clarified. The aim of our study was to clarify the association between the geriatric nutritional risk index (<i>GNRI</i>), an indicator of nutritional status, and the incidence of bone fractures in patients undergoing hemodialysis. Methods: We included 1342 registered patients undergoing hemodialysis and performed a post hoc analysis. We divided patients into the high <i>GNRI</i> group (≥92), considered to have a low risk of malnutrition, and the low <i>GNRI</i> group (<92), considered to have a high risk of malnutrition. Fracture-free survival in the low and high <i>GNRI</i> groups was evaluated by the Kaplan–Meier method. Cox proportional hazards models were used to identify the risk factors for fractures requiring hospitalization. All results were stratified by sex. Results: New bone fractures developed in 108 (8.0%) patients in 5 years of follow-up. Bone fractures occurred more frequently in the low <i>GNRI</i> group compared with the high <i>GNRI</i> group (HR: 3.51, 95% CI: 1.91–6.42, <i>p</i> < 0.01 in males; HR: 2.47, 95% CI: 1.52–4.03, <i>p</i> < 0.01 in females). A low <i>GNRI</i> was significantly associated with an increased incidence of bone fractures, even after adjustment for covariates. However, the serum levels of calcium, phosphate, parathyroid hormone, and alkaline phosphatase were not associated with the incidence of bone fractures. Conclusions: A low <i>GNRI</i> is an independent risk factor for bone fractures in patients undergoing hemodialysis. Early intervention for the low <i>GNRI</i> group may be important in preventing the occurrence of fractures. |
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| language | English |
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| series | Nutrients |
| spelling | doaj.art-fd2681db93b54e2ca26f03d0d93f7c0e2023-11-22T09:07:01ZengMDPI AGNutrients2072-66432021-08-01138284710.3390/nu13082847Lower Geriatric Nutritional Risk Index (<i>GNRI</i>) Is Associated with Higher Risk of Fractures in Patients Undergoing HemodialysisMaria Yoshida0Ayumu Nakashima1Shigehiro Doi2Kazuya Maeda3Naoki Ishiuchi4Takayuki Naito5Takao Masaki6Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, JapanDepartment of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, JapanDepartment of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, JapanDepartment of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, JapanDepartment of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, JapanIchiyokai Yokogawa Clinic, 2-7-9 Yokogawacho, Nishi-ku, Hiroshima 733-0011, JapanDepartment of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, JapanBackground: Although malnutrition and bone fracture are both major complications in patients undergoing hemodialysis, their association has not been clarified. The aim of our study was to clarify the association between the geriatric nutritional risk index (<i>GNRI</i>), an indicator of nutritional status, and the incidence of bone fractures in patients undergoing hemodialysis. Methods: We included 1342 registered patients undergoing hemodialysis and performed a post hoc analysis. We divided patients into the high <i>GNRI</i> group (≥92), considered to have a low risk of malnutrition, and the low <i>GNRI</i> group (<92), considered to have a high risk of malnutrition. Fracture-free survival in the low and high <i>GNRI</i> groups was evaluated by the Kaplan–Meier method. Cox proportional hazards models were used to identify the risk factors for fractures requiring hospitalization. All results were stratified by sex. Results: New bone fractures developed in 108 (8.0%) patients in 5 years of follow-up. Bone fractures occurred more frequently in the low <i>GNRI</i> group compared with the high <i>GNRI</i> group (HR: 3.51, 95% CI: 1.91–6.42, <i>p</i> < 0.01 in males; HR: 2.47, 95% CI: 1.52–4.03, <i>p</i> < 0.01 in females). A low <i>GNRI</i> was significantly associated with an increased incidence of bone fractures, even after adjustment for covariates. However, the serum levels of calcium, phosphate, parathyroid hormone, and alkaline phosphatase were not associated with the incidence of bone fractures. Conclusions: A low <i>GNRI</i> is an independent risk factor for bone fractures in patients undergoing hemodialysis. Early intervention for the low <i>GNRI</i> group may be important in preventing the occurrence of fractures.https://www.mdpi.com/2072-6643/13/8/2847bone fracturehemodialysismalnutritiongeriatric nutritional risk index |
| spellingShingle | Maria Yoshida Ayumu Nakashima Shigehiro Doi Kazuya Maeda Naoki Ishiuchi Takayuki Naito Takao Masaki Lower Geriatric Nutritional Risk Index (<i>GNRI</i>) Is Associated with Higher Risk of Fractures in Patients Undergoing Hemodialysis Nutrients bone fracture hemodialysis malnutrition geriatric nutritional risk index |
| title | Lower Geriatric Nutritional Risk Index (<i>GNRI</i>) Is Associated with Higher Risk of Fractures in Patients Undergoing Hemodialysis |
| title_full | Lower Geriatric Nutritional Risk Index (<i>GNRI</i>) Is Associated with Higher Risk of Fractures in Patients Undergoing Hemodialysis |
| title_fullStr | Lower Geriatric Nutritional Risk Index (<i>GNRI</i>) Is Associated with Higher Risk of Fractures in Patients Undergoing Hemodialysis |
| title_full_unstemmed | Lower Geriatric Nutritional Risk Index (<i>GNRI</i>) Is Associated with Higher Risk of Fractures in Patients Undergoing Hemodialysis |
| title_short | Lower Geriatric Nutritional Risk Index (<i>GNRI</i>) Is Associated with Higher Risk of Fractures in Patients Undergoing Hemodialysis |
| title_sort | lower geriatric nutritional risk index i gnri i is associated with higher risk of fractures in patients undergoing hemodialysis |
| topic | bone fracture hemodialysis malnutrition geriatric nutritional risk index |
| url | https://www.mdpi.com/2072-6643/13/8/2847 |
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