Association of the nutritional risk index for Japanese hemodialysis patients with long-term mortality: The Q-Cohort Study.
All-cause death
Hemodialysis
NRI-JH
Nutritional risk index for Japanese hemodialysis patients
Protein-energy wasting
Journal
Clinical and experimental nephrology
ISSN: 1437-7799
Titre abrégé: Clin Exp Nephrol
Pays: Japan
ID NLM: 9709923
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
received:
07
09
2020
accepted:
11
08
2021
pubmed:
18
8
2021
medline:
5
4
2022
entrez:
17
8
2021
Statut:
ppublish
Résumé
Protein-energy wasting (PEW) is a risk factor for mortality in patients undergoing hemodialysis. Recently, a nutritional risk index for Japanese hemodialysis patients (NRI-JH) has been proposed as a surrogate index of PEW. However, no study has determined the association of the NRI-JH with long-term mortality in patients undergoing hemodialysis. Furthermore, the validity of the NRI-JH has not been confirmed. In total, 3046 patients undergoing hemodialysis and registered in the Q-Cohort Study were followed up for 10 years. The NRI-JH was calculated on the basis of body mass index and serum levels of albumin, total cholesterol, and creatinine. The patients were divided into four groups according to the NRI-JH scores: 0-3 (G1, n = 1343), 4-7 (G2, n = 1136), 8-10 (G3, n = 321), and 11-13 (G4, n = 246). We examined the association between the NRI-JH and the 4-year and 10-year risks of all-cause, cardiovascular, and infection-related deaths using the Cox proportional hazards model. During the follow-up period, 647 patients died during the first 4 years, and 1503 patients died within 10 years. The 4-year prognosis was analyzed and compared with the lowest NRI-JH score group. Multivariable-adjusted hazard ratios (95% confidence intervals) for all-cause death were 1.93 (1.57-2.38), 2.68 (2.05-3.50), and 3.16 (2.40-4.16) in the G2, G3, and G4 groups, respectively. Similarly, a higher NRI-JH score was associated with an increased risk of cardiovascular and infection-related deaths. A higher NRI-JH score was associated with an increased risk of long-term mortality in patients undergoing maintenance hemodialysis. The study protocol was registered in the University Hospital Medical Information Network (UMIN) clinical trial registry (UMIN ID: 000000556).
Sections du résumé
BACKGROUND
BACKGROUND
Protein-energy wasting (PEW) is a risk factor for mortality in patients undergoing hemodialysis. Recently, a nutritional risk index for Japanese hemodialysis patients (NRI-JH) has been proposed as a surrogate index of PEW. However, no study has determined the association of the NRI-JH with long-term mortality in patients undergoing hemodialysis. Furthermore, the validity of the NRI-JH has not been confirmed.
METHODS
METHODS
In total, 3046 patients undergoing hemodialysis and registered in the Q-Cohort Study were followed up for 10 years. The NRI-JH was calculated on the basis of body mass index and serum levels of albumin, total cholesterol, and creatinine. The patients were divided into four groups according to the NRI-JH scores: 0-3 (G1, n = 1343), 4-7 (G2, n = 1136), 8-10 (G3, n = 321), and 11-13 (G4, n = 246). We examined the association between the NRI-JH and the 4-year and 10-year risks of all-cause, cardiovascular, and infection-related deaths using the Cox proportional hazards model.
RESULTS
RESULTS
During the follow-up period, 647 patients died during the first 4 years, and 1503 patients died within 10 years. The 4-year prognosis was analyzed and compared with the lowest NRI-JH score group. Multivariable-adjusted hazard ratios (95% confidence intervals) for all-cause death were 1.93 (1.57-2.38), 2.68 (2.05-3.50), and 3.16 (2.40-4.16) in the G2, G3, and G4 groups, respectively. Similarly, a higher NRI-JH score was associated with an increased risk of cardiovascular and infection-related deaths.
CONCLUSION
CONCLUSIONS
A higher NRI-JH score was associated with an increased risk of long-term mortality in patients undergoing maintenance hemodialysis.
TRIAL REGISTRATION
BACKGROUND
The study protocol was registered in the University Hospital Medical Information Network (UMIN) clinical trial registry (UMIN ID: 000000556).
Identifiants
pubmed: 34403008
doi: 10.1007/s10157-021-02124-6
pii: 10.1007/s10157-021-02124-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
59-67Subventions
Organisme : Kidney Foundation, Japan
ID : H19 JKFB 07-13
Organisme : Kidney Foundation, Japan
ID : H20 JKFB 08-8
Organisme : Kidney Foundation, Japan
ID : H23 JKFB 11-11
Informations de copyright
© 2021. Japanese Society of Nephrology.
Références
Ikizler TA, Cano NJ, Franch H, Fouque D, Himmelfarb J, Kalantar-Zadeh K, et al. Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International society of renal nutrition and metabolism. Kidney Int. 2013;84(6):1096–107.
doi: 10.1038/ki.2013.147
Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int. 2008;73(4):391–8.
doi: 10.1038/sj.ki.5002585
Koppe L, Fouque D, Kalantar-Zadeh K. Kidney cachexia or protein-energy wasting in chronic kidney disease: facts and numbers. J Cachexia Sarcopenia Muscle. 2019;10(3):479–84.
doi: 10.1002/jcsm.12421
Carrero JJ, Thomas F, Nagy K, Arogundade F, Avesani CM, Chan M, 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 Ren Nutr. 2018;28(6):380–92.
doi: 10.1053/j.jrn.2018.08.006
Rambod M, Bross R, Zitterkoph J, Benner D, Pithia J, Colman S, et al. Association of malnutrition-inflammation score with quality of life and mortality in hemodialysis patients: a 5-year prospective cohort study. Am J Kidney Dis. 2009;53(2):298–309.
doi: 10.1053/j.ajkd.2008.09.018
de Mutsert R, Grootendorst DC, Axelsson J, Boeschoten EW, Krediet RT, Dekker FW. Excess mortality due to interaction between protein-energy wasting, inflammation and cardiovascular disease in chronic dialysis patients. Nephrol Dial Transpl. 2008;23(9):2957–64.
doi: 10.1093/ndt/gfn167
Kanda E, Kato A, Masakane I, Kanno Y. A new nutritional risk index for predicting mortality in hemodialysis patients: nationwide cohort study. PLoS ONE. 2019;14(3):e0214524.
doi: 10.1371/journal.pone.0214524
Yamada S, Taniguchi M, Tokumoto M, Yoshitomi R, Yoshida H, Tatsumoto N, et al. Modified creatinine index and the risk of bone fracture in patients undergoing hemodialysis: the Q-cohort study. Am J Kidney Dis. 2017;70(2):270–80.
doi: 10.1053/j.ajkd.2017.01.052
Tanaka S, Ninomiya T, Taniguchi M, Fujisaki K, Tokumoto M, Hirakata H, et al. Comparison of oral versus intravenous vitamin D receptor activator in reducing infection-related mortality in hemodialysis patients: the Q-cohort study. Nephrol Dial Transpl. 2016;31(7):1152–60.
doi: 10.1093/ndt/gfw205
Eriguchi R, Taniguchi M, Ninomiya T, Hirakata H, Fujimi S, Tsuruya K, et al. Hyporesponsiveness to erythropoiesis-stimulating agent as a prognostic factor in Japanese hemodialysis patients: the Q-cohort study. J Nephrol. 2015;28(2):217–25.
doi: 10.1007/s40620-014-0121-9
Tanaka S, Ninomiya T, Hiyamuta H, Taniguchi M, Tokumoto M, Masutani K, et al. Apparent treatment-resistant hypertension and cardiovascular risk in hemodialysis patients: ten-year outcomes of the Q-cohort study. Sci Rep. 2019;9(1):1043.
doi: 10.1038/s41598-018-37961-1
Arase H, Yamada S, Hiyamuta H, Taniguchi M, Tokumoto M, Tsuruya K, et al. Modified creatinine index and risk for long-term infection-related mortality in hemodialysis patients: ten-year outcomes of the Q-cohort study. Sci Rep. 2020;10(1):1241.
doi: 10.1038/s41598-020-58181-6
Nakano T, Hiyamuta H, Yotsueda R, Tanaka S, Taniguchi M, Tsuruya K, et al. Higher cholesterol level predicts cardiovascular event and inversely associates with mortality in hemodialysis patients: 10-year outcomes of the Q-cohort study. Ther Apher Dial. 2020;24(4):431–8.
doi: 10.1111/1744-9987.13455
Kazama JJ. Japanese society of dialysis therapy treatment guidelines for secondary hyperparathyroidism. Ther Apher Dial. 2007;11(Suppl 1):S44–7.
doi: 10.1111/j.1744-9987.2007.00516.x
Payne RB, Little AJ, Williams RB, Milner JR. Interpretation of serum calcium in patients with abnormal serum proteins. Br Med J. 1973;4(5893):643–6.
doi: 10.1136/bmj.4.5893.643
Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transpl. 2013;48(3):452–8.
doi: 10.1038/bmt.2012.244
Carrero JJ, Stenvinkel P, Cuppari L, Ikizler TA, Kalantar-Zadeh K, Kaysen G, et al. Etiology of the protein-energy wasting syndrome in chronic kidney disease: a consensus statement from the international society of renal nutrition and metabolism (ISRNM). J Ren Nutr. 2013;23(2):77–90.
doi: 10.1053/j.jrn.2013.01.001
Sabatino A, Regolisti G, Karupaiah T, Sahathevan S, Singh BKS, Khor BH, et al. Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on hemodialysis. Clin Nutr. 2017;36(3):663–71.
doi: 10.1016/j.clnu.2016.06.007
Kovesdy CP, Kalantar-Zadeh K. Why is protein-energy wasting associated with mortality in chronic kidney disease? Semin Nephrol. 2009;29(1):3–14.
doi: 10.1016/j.semnephrol.2008.10.002
Pedersen BK, Febbraio MA. Muscles, exercise and obesity: skeletal muscle as a secretory organ. Nat Rev Endocrinol. 2012;8(8):457–65.
doi: 10.1038/nrendo.2012.49
Carrero JJ, Nakashima A, Qureshi AR, Lindholm B, Heimburger O, Barany P, et al. Protein-energy wasting modifies the association of ghrelin with inflammation, leptin, and mortality in hemodialysis patients. Kidney Int. 2011;79(7):749–56.
doi: 10.1038/ki.2010.487
Campbell GA, Patrie JT, Gaylinn BD, Thorner MO, Bolton WK. Oral ghrelin receptor agonist mk-0677 increases serum insulin-like growth factor 1 in hemodialysis patients: a randomized blinded study. Nephrol Dial Transpl. 2018;33(3):523–30.
doi: 10.1093/ndt/gfw474
van Zuijdewijn CLDR, ter Wee PM, Chapdelaine I, Bots ML, Blankestijn PJ, van den Dorpel MA, et al. A comparison of 8 nutrition-related tests to predict mortality in hemodialysis patients. J Ren Nutr. 2015;25(5):412–9.
doi: 10.1053/j.jrn.2015.02.005
Kalantar-Zadeh K, Abbott KC, Salahudeen AK, Kilpatrick RD, Horwich TB. Survival advantages of obesity in dialysis patients. Am J Clin Nutr. 2005;81(3):543–54.
doi: 10.1093/ajcn/81.3.543
Kalantar-Zadeh K, Cano NJ, Budde K, Chazot C, Kovesdy CP, Mak RH, et al. Diets and enteral supplements for improving outcomes in chronic kidney disease. Nat Rev Nephrol. 2011;7(7):369–84.
doi: 10.1038/nrneph.2011.60
Iseki K, Yamazato M, Tozawa M, Takishita S. Hypocholesterolemia is a significant predictor of death in a cohort of chronic hemodialysis patients. Kidney Int. 2002;61(5):1887–93.
doi: 10.1046/j.1523-1755.2002.00324.x
Huang CX, Tighiouart H, Beddhu S, Cheung AK, Dwyer JT, Eknoyan G, et al. Both low muscle mass and low fat are associated with higher all-cause mortality in hemodialysis patients. Kidney Int. 2010;77(7):624–9.
doi: 10.1038/ki.2009.524
Walther CP, Carter CW, Low CL, Williams P, Rifkin DE, Steiner RW, et al. Interdialytic creatinine change versus predialysis creatinine as indicators of nutritional status in maintenance hemodialysis. Nephrol Dial Transpl. 2012;27(2):771–6.
doi: 10.1093/ndt/gfr389
Young HML, March DS, Graham-Brown MPM, Jones AW, Curtis F, Grantham CS, et al. Effects of intradialytic cycling exercise on exercise capacity, quality of life, physical function and cardiovascular measures in adult haemodialysis patients: a systematic review and meta-analysis. Nephrol Dial Transpl. 2018;33(8):1436–45.
doi: 10.1093/ndt/gfy045