Ling A.1, Yee C.F 1, Liang Z.H.1, Lim C.H.1, Khan A.B.2
1 Dietetics Department, The National Kidney Foundation Singapore
2 Medical Services Department, The National Kidney Foundation Singapore
GNRI is one of the nutrition screening tools in elderly HD patients (≥65 year-old) and some evidences of the application in younger patients (YP). This study aims to ascertain the predictive value of GNRI for malnutrition in HD patients in Singapore.
A retrospective observational cohort study was conducted in HD patients aged ≥18 year-old with HD duration >3 months recruited from NKF dialysis centers in Singapore between year 2014 and 2017. 7-point Subjective Global Assessment (SGA) was used to assess patient’s nutritional status. Malnutrition was defined by SGA≤5. GNRI values were calculated using information obtained from clinical database. GNRI cutoff was set at 91.2. Agreement of GNRI and SGA was assessed using Cohen’s Kappa test; logistics regression test was used to calculate the predictive value of GNRI for malnutrition. Statistical significance was set at p<0.05.
Results & Discussion
Total 586 patients were recruited in this study, 58% aged <65year-old, 55% male, BMI 24.1±4.9kg/m2, median dialysis vintage 7 months (interquartile range 5-27 months) and 68.8% diabetic. Among them, 40.3% malnourished and 19.7% with low GNRI in YP compared to 63% malnourished and 32.1% with low GNRI in elder patients (EP). According to Cohen’s Kappa test, the agreement between GNRI and SGA was fair for both younger and elderly HD patients (0.293 and 0.301 respectively, p<0.001). There is statistical significance predictive value of GNRI (categorical and continuous GNRI) for malnutrition after case adjustment on gender, race, Diabetes status, dialysis vintage and acuity status (categorical GNRI, YP: Odd Ratio (OR)=5.35 (95% CI 2.79-10.25), p<0.001 and EP: OR=7.80 (95% CI 3.60-16.90), p<0.001; continuous GNRI, YP: OR=0.85 (95% CI 0.80-0.89), p<0.001 and EP: OR=0.82 (95% CI 0.77-0.88), p<0.001).
This study suggests that GNRI is able to predict nutritional status defined by SGA in both younger and elderly HD patients, at NKF Singapore.