Combined Predictive Value of Extracellular Fluid/Intracellular Fluid Ratio and the Geriatric Nutritional Risk Index for Mortality in Patients Undergoing Hemodialysis
The ratio of extracellular fluid (ECF) to intracellular fluid (ICF) may be associated with mortality in patients undergoing hemodialysis, possibly associated with protein-energy wasting. We therefore investigated the relationship of the ECF/ICF ratio and the geriatric nutritional risk index (GNRI) w...
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| description | The ratio of extracellular fluid (ECF) to intracellular fluid (ICF) may be associated with mortality in patients undergoing hemodialysis, possibly associated with protein-energy wasting. We therefore investigated the relationship of the ECF/ICF ratio and the geriatric nutritional risk index (GNRI) with the all-cause and cardiovascular-specific mortality in 234 patients undergoing hemodialysis. Bioimpedance analysis of the ECF and ICF was performed and the ECF/ICF ratio was independently associated with GNRI (β = -0.247,
< 0.0001). During a median follow-up of 2.8 years, 72 patients died, of which 29 were cardiovascular. All-cause mortality was independently associated with a lower GNRI (adjusted hazard ratio [aHR] 3.48, 95% confidence interval [CI] 2.01-6.25) and a higher ECF/ICF ratio (aHR 11.38, 95%CI 5.29-27.89). Next, we divided patients into four groups: group 1 (G1), higher GNRI and lower ECF/ICF ratio; G2, lower GNRI and lower ECF/ICF ratio; G3, higher GNRI and higher ECF/ICF ratio; and G4, lower GNRI and higher ECF/ICF ratio. Analysis of these groups revealed 10-year survival rates of 91.2%, 67.2%, 0%, and 0% in G1, G2, G3, and G4, respectively. The aHR for G4 versus G1 was 43.4 (95%CI 12.2-279.8). Adding the GNRI alone, the ECF/ICF ratio alone, or both to the established risk model improved the net reclassification improvement by 0.444, 0.793 and 0.920, respectively. Similar results were obtained for cardiovascular mortality. In conclusion, the ECF/ICF ratio was independently associated with GNRI and could predict mortality in patients undergoing hemodialysis. Combining the GNRI and ECF/ICF ratio could improve mortality predictions. |
| doi_str_mv | 10.3390/nu11112659 |
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< 0.0001). During a median follow-up of 2.8 years, 72 patients died, of which 29 were cardiovascular. All-cause mortality was independently associated with a lower GNRI (adjusted hazard ratio [aHR] 3.48, 95% confidence interval [CI] 2.01-6.25) and a higher ECF/ICF ratio (aHR 11.38, 95%CI 5.29-27.89). Next, we divided patients into four groups: group 1 (G1), higher GNRI and lower ECF/ICF ratio; G2, lower GNRI and lower ECF/ICF ratio; G3, higher GNRI and higher ECF/ICF ratio; and G4, lower GNRI and higher ECF/ICF ratio. Analysis of these groups revealed 10-year survival rates of 91.2%, 67.2%, 0%, and 0% in G1, G2, G3, and G4, respectively. The aHR for G4 versus G1 was 43.4 (95%CI 12.2-279.8). Adding the GNRI alone, the ECF/ICF ratio alone, or both to the established risk model improved the net reclassification improvement by 0.444, 0.793 and 0.920, respectively. Similar results were obtained for cardiovascular mortality. In conclusion, the ECF/ICF ratio was independently associated with GNRI and could predict mortality in patients undergoing hemodialysis. Combining the GNRI and ECF/ICF ratio could improve mortality predictions.</description><identifier>ISSN: 2072-6643</identifier><identifier>EISSN: 2072-6643</identifier><identifier>DOI: 10.3390/nu11112659</identifier><identifier>PMID: 31690024</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Aged ; Angina pectoris ; Atherosclerosis ; bioelectrical impedance ; Blood pressure ; Body composition ; Cardiovascular disease ; Cardiovascular diseases ; confidence interval ; Diabetes ; Extracellular Fluid ; Geriatric Assessment - methods ; Geriatrics ; Health risk assessment ; Heart failure ; Hemodialysis ; Hospitals ; Humans ; Hypertension ; Inflammation ; Intracellular Fluid ; intracellular fluids ; Malnutrition ; Middle Aged ; Mortality ; Nutrition Assessment ; nutrition risk assessment ; Nutritional Status ; Patients ; prediction ; Proteins ; Renal Dialysis - mortality ; Renal Insufficiency, Chronic ; Risk Factors ; Survival ; survival rate</subject><ispartof>Nutrients, 2019-11, Vol.11 (11), p.2659</ispartof><rights>2019. This work is licensed under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 by the authors. 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c439t-d4bb391dc711b9959d4938af5227f705d5f8e76986c28b5800f9912b1c0f59903</citedby><cites>FETCH-LOGICAL-c439t-d4bb391dc711b9959d4938af5227f705d5f8e76986c28b5800f9912b1c0f59903</cites><orcidid>0000-0002-8180-5614</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893674/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893674/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31690024$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yajima, Takahiro</creatorcontrib><creatorcontrib>Yajima, Kumiko</creatorcontrib><creatorcontrib>Takahashi, Hiroshi</creatorcontrib><creatorcontrib>Yasuda, Keigo</creatorcontrib><title>Combined Predictive Value of Extracellular Fluid/Intracellular Fluid Ratio and the Geriatric Nutritional Risk Index for Mortality in Patients Undergoing Hemodialysis</title><title>Nutrients</title><addtitle>Nutrients</addtitle><description>The ratio of extracellular fluid (ECF) to intracellular fluid (ICF) may be associated with mortality in patients undergoing hemodialysis, possibly associated with protein-energy wasting. We therefore investigated the relationship of the ECF/ICF ratio and the geriatric nutritional risk index (GNRI) with the all-cause and cardiovascular-specific mortality in 234 patients undergoing hemodialysis. Bioimpedance analysis of the ECF and ICF was performed and the ECF/ICF ratio was independently associated with GNRI (β = -0.247,
< 0.0001). During a median follow-up of 2.8 years, 72 patients died, of which 29 were cardiovascular. All-cause mortality was independently associated with a lower GNRI (adjusted hazard ratio [aHR] 3.48, 95% confidence interval [CI] 2.01-6.25) and a higher ECF/ICF ratio (aHR 11.38, 95%CI 5.29-27.89). Next, we divided patients into four groups: group 1 (G1), higher GNRI and lower ECF/ICF ratio; G2, lower GNRI and lower ECF/ICF ratio; G3, higher GNRI and higher ECF/ICF ratio; and G4, lower GNRI and higher ECF/ICF ratio. Analysis of these groups revealed 10-year survival rates of 91.2%, 67.2%, 0%, and 0% in G1, G2, G3, and G4, respectively. The aHR for G4 versus G1 was 43.4 (95%CI 12.2-279.8). Adding the GNRI alone, the ECF/ICF ratio alone, or both to the established risk model improved the net reclassification improvement by 0.444, 0.793 and 0.920, respectively. Similar results were obtained for cardiovascular mortality. In conclusion, the ECF/ICF ratio was independently associated with GNRI and could predict mortality in patients undergoing hemodialysis. Combining the GNRI and ECF/ICF ratio could improve mortality predictions.</description><subject>Aged</subject><subject>Angina pectoris</subject><subject>Atherosclerosis</subject><subject>bioelectrical impedance</subject><subject>Blood pressure</subject><subject>Body composition</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>confidence interval</subject><subject>Diabetes</subject><subject>Extracellular Fluid</subject><subject>Geriatric Assessment - methods</subject><subject>Geriatrics</subject><subject>Health risk assessment</subject><subject>Heart failure</subject><subject>Hemodialysis</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Inflammation</subject><subject>Intracellular Fluid</subject><subject>intracellular fluids</subject><subject>Malnutrition</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Nutrition Assessment</subject><subject>nutrition risk assessment</subject><subject>Nutritional Status</subject><subject>Patients</subject><subject>prediction</subject><subject>Proteins</subject><subject>Renal Dialysis - mortality</subject><subject>Renal Insufficiency, Chronic</subject><subject>Risk Factors</subject><subject>Survival</subject><subject>survival rate</subject><issn>2072-6643</issn><issn>2072-6643</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkltrFTEQxxdRbKl98QPIgC8inDaXTXbzIsihlwNVS7G-LtlcTlOzSU2ypecD-T3d7c2qD87LhJlf_swM_6p6jdEepQLthxFPQTgTz6ptghqy4Lymz5-8t6rdnC_RHA1qOH1ZbVHMBUKk3q5-LuPQu2A0nCajnSru2sA36UcD0cLBTUlSGe9HLxMc-tHp_VX4pwZnsrgIMmgoFwaOTHKyJKfg8zilqRWkhzOXv8MqaHMDNib4FFOR3pUNuACn038TSobzqZ_W0YU1HJshaif9Jrv8qnphpc9m9z7vVOeHB1-Xx4uTL0er5ceThaqpKAtd9z0VWKsG414IJnQtaCstI6SxDWKa2dY0XLRckbZnLUJWCEx6rJBlQiC6U324070a-8FoZeZdfXeV3CDTpovSdX92grvo1vG6462gvKkngXf3Ain-GE0u3eDyfCwZTBxzR2qE6pYQQf-PUkwYo-R2rLd_oZdxTNNRbylWtwKRmXp_R6kUc07GPs6NUTd7pfvtlQl-83TTR_TBGfQXaNW7sQ</recordid><startdate>20191104</startdate><enddate>20191104</enddate><creator>Yajima, Takahiro</creator><creator>Yajima, Kumiko</creator><creator>Takahashi, Hiroshi</creator><creator>Yasuda, Keigo</creator><general>MDPI AG</general><general>MDPI</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>7S9</scope><scope>L.6</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-8180-5614</orcidid></search><sort><creationdate>20191104</creationdate><title>Combined Predictive Value of Extracellular Fluid/Intracellular Fluid Ratio and the Geriatric Nutritional Risk Index for Mortality in Patients Undergoing Hemodialysis</title><author>Yajima, Takahiro ; Yajima, Kumiko ; Takahashi, Hiroshi ; Yasuda, Keigo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c439t-d4bb391dc711b9959d4938af5227f705d5f8e76986c28b5800f9912b1c0f59903</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Angina pectoris</topic><topic>Atherosclerosis</topic><topic>bioelectrical impedance</topic><topic>Blood pressure</topic><topic>Body composition</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular diseases</topic><topic>confidence interval</topic><topic>Diabetes</topic><topic>Extracellular Fluid</topic><topic>Geriatric Assessment - methods</topic><topic>Geriatrics</topic><topic>Health risk assessment</topic><topic>Heart failure</topic><topic>Hemodialysis</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Inflammation</topic><topic>Intracellular Fluid</topic><topic>intracellular fluids</topic><topic>Malnutrition</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Nutrition Assessment</topic><topic>nutrition risk assessment</topic><topic>Nutritional Status</topic><topic>Patients</topic><topic>prediction</topic><topic>Proteins</topic><topic>Renal Dialysis - mortality</topic><topic>Renal Insufficiency, Chronic</topic><topic>Risk Factors</topic><topic>Survival</topic><topic>survival rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yajima, Takahiro</creatorcontrib><creatorcontrib>Yajima, Kumiko</creatorcontrib><creatorcontrib>Takahashi, Hiroshi</creatorcontrib><creatorcontrib>Yasuda, Keigo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Physical Education Index</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>AGRICOLA</collection><collection>AGRICOLA - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Nutrients</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yajima, Takahiro</au><au>Yajima, Kumiko</au><au>Takahashi, Hiroshi</au><au>Yasuda, Keigo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Combined Predictive Value of Extracellular Fluid/Intracellular Fluid Ratio and the Geriatric Nutritional Risk Index for Mortality in Patients Undergoing Hemodialysis</atitle><jtitle>Nutrients</jtitle><addtitle>Nutrients</addtitle><date>2019-11-04</date><risdate>2019</risdate><volume>11</volume><issue>11</issue><spage>2659</spage><pages>2659-</pages><issn>2072-6643</issn><eissn>2072-6643</eissn><abstract>The ratio of extracellular fluid (ECF) to intracellular fluid (ICF) may be associated with mortality in patients undergoing hemodialysis, possibly associated with protein-energy wasting. We therefore investigated the relationship of the ECF/ICF ratio and the geriatric nutritional risk index (GNRI) with the all-cause and cardiovascular-specific mortality in 234 patients undergoing hemodialysis. Bioimpedance analysis of the ECF and ICF was performed and the ECF/ICF ratio was independently associated with GNRI (β = -0.247,
< 0.0001). During a median follow-up of 2.8 years, 72 patients died, of which 29 were cardiovascular. All-cause mortality was independently associated with a lower GNRI (adjusted hazard ratio [aHR] 3.48, 95% confidence interval [CI] 2.01-6.25) and a higher ECF/ICF ratio (aHR 11.38, 95%CI 5.29-27.89). Next, we divided patients into four groups: group 1 (G1), higher GNRI and lower ECF/ICF ratio; G2, lower GNRI and lower ECF/ICF ratio; G3, higher GNRI and higher ECF/ICF ratio; and G4, lower GNRI and higher ECF/ICF ratio. Analysis of these groups revealed 10-year survival rates of 91.2%, 67.2%, 0%, and 0% in G1, G2, G3, and G4, respectively. The aHR for G4 versus G1 was 43.4 (95%CI 12.2-279.8). Adding the GNRI alone, the ECF/ICF ratio alone, or both to the established risk model improved the net reclassification improvement by 0.444, 0.793 and 0.920, respectively. Similar results were obtained for cardiovascular mortality. In conclusion, the ECF/ICF ratio was independently associated with GNRI and could predict mortality in patients undergoing hemodialysis. Combining the GNRI and ECF/ICF ratio could improve mortality predictions.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>31690024</pmid><doi>10.3390/nu11112659</doi><orcidid>https://orcid.org/0000-0002-8180-5614</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Angina pectoris Atherosclerosis bioelectrical impedance Blood pressure Body composition Cardiovascular disease Cardiovascular diseases confidence interval Diabetes Extracellular Fluid Geriatric Assessment - methods Geriatrics Health risk assessment Heart failure Hemodialysis Hospitals Humans Hypertension Inflammation Intracellular Fluid intracellular fluids Malnutrition Middle Aged Mortality Nutrition Assessment nutrition risk assessment Nutritional Status Patients prediction Proteins Renal Dialysis - mortality Renal Insufficiency, Chronic Risk Factors Survival survival rate |
| title | Combined Predictive Value of Extracellular Fluid/Intracellular Fluid Ratio and the Geriatric Nutritional Risk Index for Mortality in Patients Undergoing Hemodialysis |
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