Geriatric Nutritional Risk Index as a Screening Tool for Malnutrition in Patients on Chronic Peritoneal Dialysis
published online 13 July 2009.
Background
Malnutrition is common among peritoneal dialysis (PD) patients. Recently, the Geriatric Nutrition Risk Index (GNRI) was found to be a reliable tool for screening malnutrition in hemodialysis patients. However, the GNRI has not been validated in PD patients.
Methods
We studied 314 unselected, adult PD patients from a single dialysis unit. We compared their GNRI scores with their comprehensive Malnutrition-Inflammation Scores (MIS) and 7-point Subjective Global Assessment (SGA) scores. We randomly selected 106 patients for a repeated assessment, and the changes in their three indices were compared.
Results
Baseline GNRI was significantly correlated with MIS (r = −0.487, P < .0001) and SGA (r = 0.234, P < .0001). When MIS ≥6 was defined as malnutrition, the sensitivity and specificity of GNRI ≤93 in predicting malnutrition were 68.0% and 67.7%, respectively. When SGA ≤5 was used to define malnutrition, the sensitivity and specificity were 54.5% and 71.1%, respectively. The change in GNRI was correlated with the change in MIS (r = −0.244, P = .012) and overall SGA score (r = 0.266, P = .006), respectively. When an increase in MIS was defined as a worsening of nutrition, the sensitivity and specificity of GNRI were 45.7% and 81.7%, respectively. When a decrease in SGA was used to define a worsening of nutrition, the sensitivity and specificity were 42.3% and 87.0%, respectively.
Conclusions
Although GNRI is significantly correlated with other nutritional indices, it is not sensitive for screening malnutrition in PD patients. Serial measurements of GNRI are also not sensitive in detecting a change in nutritional status. Further study is needed to identify a simple and reliable tool for the assessment and monitoring of nutritional status in PD patients.
Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong, China
Address reprint requests to Cheuk-Chun Szeto, MD, FRCP (Edin), Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong, China.
ABSTRACT