Abstract

Background

Malnutrition is common and associated with poor outcomes in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Recently, the geriatric nutritional risk index (GNRI) was reported as a novel tool for evaluating nutritional status. However, the association between GNRI and renal outcome, cardiovascular (CVD) events, and mortality in patients with CKD remains unclear.

Methods

A prospective cohort study with adult patients with CKD stages 1–4 was conducted at 39 centers around China starting in 2011. Patients were divided into quartiles (Q1, Q2, Q3, and Q4) according to their GNRI category.

Results

A total of 2791 CKD patients within a median follow-up of 4.38 years were included. A low GNRI quartile was independently associated with progression to ESRD, CVD events, and overall mortality. Compared to that in the Q1 group (the reference group), belonging to a higher GNRI quartile significantly reduced the risk of progression to ESRD in the crude and multivariate-adjusted models. Moreover, a significant inverse association was found between those in the high GNRI quartiles and overall mortality among patients with CKD (HR 0.25; 95% CI 0.15–0.43; p = 0.0007, Q4 vs. Q1) after multivariate adjustment. In addition, there was also a significant association between GNRI and CVD events (HR 0.57; 95% CI 0.39–0.84; p = 0.005, Q4 vs. Q1). Moreover, after adjusting for other confounders, only the Q3 group remained significantly fewer CVD events (HR 0.44; 95% CI 0.19–0.98; p = 0.04).

Conclusions

These findings suggest that GNRI might be a useful prognostic tool for patients with CKD.