Abstract
Aim: In our study, it was aimed to evaluate the nutritional status of chronic kidney patients with Geriatric nutritional risk index (GNRI).
Materials and methods: A total of 170 patients were included in the study, 81 male and 89 women with follow-up with the diagnosis of Stage 3-4-5 Chronic Kidney Disease (CHD), which was applied to The Nephrology Outpatient Clinic of Zonguldak Bülent Ecevit University Faculty of Medicine between November 2018 and November 2019. Presence of malnutrition in patients; biochemical parameters and GNRI were calculated and evaluated. Statistical analysis was done using SPSS 19.0 program. The calculated p<0.05 was considered significant
Results: In our study, the relationship between biochemical nutritional parameters and GNRI was evaluated. According to the highest positive likelihood ratio, the GNRI cut-off value was calculated as 110 for malnutrition.. Patients with low GNRI were found to have significantly lower BMI (p <0.05). In addition, serum albumin level, hemoglobin, calcium, total lymphocyte count, total protein levels, total iron binding capacity and glomerular filtraton rate (GFR) were significantly lower in patients with GNRI≤110 (p<0.05). Urea, creatinine, ferritin, parathormone levels and sedimentation values were also found to be significantly higher in patients with low GNRI (p <0.05). When another reliable malnutrition evaluation system, Malnutrition Inflammation Score (MIS) square, was evaluated, a statistically significant negative correlation was found (p <0.05 r = -0.715).
Conclusion: Malnutrition is the leading cause of mortality in chronic kidney disease. Geriatric Nutritional Risk Index is used for malnutrition analyses, calculated according to height, weight and serum albumin level and it is reliable as it is a simple, objective evaluation system. In our study, nutritional parameters of chronic kidney patients were evaluated with GNRI and it was observed that these parameters affected similarly with the studies performed. In addition, in our study, GNRI was a reliable evaluation system in comparison with another reliable evaluation system, MIS.
References
- 1. SÜLEYMANLAR G. Kronik böbrek hastalığı ve yetmezliği: tanımı, evreleri ve epidemiyolojisi. 2007;3(38):1-7.
- 2. Sanyaolu A, Okorie C, Annan R, Turkey H, Akhtar N, Gray F, et al. Epidemiology and management of chronic renal failure: a global public health problem. 2018;1(1):11-6.
- 3. Süleymanlar G, Utaş C, Arinsoy T, Ateş K, Altun B, Altiparmak MR, et al. A population-based survey of Chronic REnal Disease In Turkey—the CREDIT study. 2010;26(6):1862-71
- 4. Registry of the Nephrology, Dialysis And Transplantation in Turkey Regıstry 2016
- 5. Yenice M. Kronik Böbrek Yetmezliği. Arık N (Editör). Deniz matbaacılık, 1.baskı, 2001; 212-24.
- 6. 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. 2008;73(4):391-8.
- 7. Yamada K, Furuya R, Takita T, Maruyama Y, Yamaguchi Y, Ohkawa S, et al. Simplified nutritional screening tools for patients on maintenance hemodialysis. 2008;87(1):106-13.
- 8. Kobayashi I, Ishimura E, Kato Y, Okuno S, Yamamoto T, Yamakawa T, et al. Geriatric Nutritional Risk Index, a simplified nutritional screening index, is a significant predictor of mortality in chronic dialysis patients. 2010;25(10):3361-5.
- 9. Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent J-P, Nicolis I, et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. 2005;82(4):777-83.
- 10. Kiuchi A, Ohashi Y, Tai R, Aoki T, Mizuiri S, Ogura T, et al. Association between low dietary protein intake and geriatric nutrition risk index in patients with chronic kidney disease: A retrospective single-center cohort study. 2016;8(10):662.
- 11. Kuo I, Huang J-C, Wu P-Y, Chen S-C, Chang J-M, Chen H-CJN. A low geriatric nutrition risk index is associated with progression to dialysis in patients with chronic kidney disease. 2017;9(11):1228.
- 12. Chung S, Koh ES, Shin SJ, Park CW. Malnutrition in patients with chronic kidney disease. Open Journal of Internal Medicine. 2012;2(02):89.
- 13. Park JH, Kim SB, Shin HS, Jung YS, Rim H. Geriatric nutritional risk index may be a significant predictor of mortality in Korean hemodialysis patients: a single center study. Therapeutic Apheresis Dialysis 2012;16(2):121-6.
- 14. Nguyen‐Khoa T, Massy ZA, De Bandt JP, Kebede M, Salama L, Lambrey G, et al. Oxidative stress and haemodialysis: role of inflammation and duration of dialysis treatment. 2001;16(2):335-40.
- 15. Stenvinkel P, Heimbürger O, Lindholm B, Kaysen GA, Bergström J. Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrology Dialysis Transplantation. 2000;15(7):953-60.
- 16. Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH. A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. American journal of kidney diseases. 2001;38(6):1251-63.
- 17. Ülger Z, Halil M, Kalan I, Yavuz BB, Cankurtaran M, Güngör E, et al. Comprehensive assessment of malnutrition risk and related factors in a large group of community-dwelling older adults. Clinical Nutrition. 2010;29(4):507-11.
Abstract
Amaç: Bu çalışmada kronik böbrek hastalarının beslenme durumlarının geriatrik nütrisyonel risk indeksi (GNRI) ile değerlendirilmesi amaçlanmıştır.
Materyal ve Metot: Çalışmaya Zonguldak Bülent Ecevit Üniversitesi Tıp Fakültesi Nefroloji Polikliniğine Kasım 2018- Kasım 2019 tarihleri arasında başvuran Evre 3-4-5 Kronik böbrek hastalığı (KBH) tanısıyla takipli 81 erkek 89 kadın toplamda 170 hasta dahil edildi. Hastalarda malnütrisyon varlığı; biyokimyasal parametreler ve GNRI hesaplanılarak değerlendirildi. İstatistiksel inceleme, SPSS 19.0 programı kullanılarak yapıldı. Hesaplanan p<0.05 anlamlı kabul edildi.
Bulgular: Çalışmamızda biyokimyasal nütrisyon parametreleri ile GNRI arasındaki ilişki değerlendirilmiştir. En yüksek pozitif olabilirlik oranına göre malnütrisyon için GNRI cut-off değeri 110 olarak hesaplanmıştır. Düşük GNRI’ ye sahip hastaların anlamlı olarak daha düşük vücut kitle indeksine (VKİ) sahip olduğu görülmüştür (p<0.05). Ayrıca GNRI≤110 olan hastalarda serum albümin düzeyi, hemoglobin, kalsiyum, lenfosit, total protein düzeyleri, total demir bağlama kapasitesi ve glomerüler filtrasyon hızı (GFH) anlamlı olarak daha düşük tespit edilmiştir (p<0.05). Düşük GNRI’ ye sahip hastalarda üre, kreatinin, ferritin, parathormon düzeyleri ve sedimentasyon değerleri de anlamlı olarak daha yüksek tespit edilmiştir (p<0.05). Bir diğer güvenilir malnütrisyon değerlendirme sistemi olan Malnütrisyon İnflamasyon Skoru (MIS) korelasyonu değerlendirildiğinde istatiksel olarak anlamlı negatif korelasyon saptanmıştır (p.0,05 r= -0.715).
Sonuç: Kronik böbrek hastalığında mortaliteyi etkileyen sebeplerin başında malnütrisyon gelmektedir. GNRI, malnütrisyon değerlendirilmesinde boy, kilo ve serum albümin düzeyine göre hesaplanmakta olup objektif bir değerlendirme sistemi olması nedeniyle güvenilirdir. Çalışmamızda kronik böbrek hastalarının nütrisyon parametreleri GNRI ile değerlendirilmiş olup bu parametreleri yapılan çalışmalarla benzer şekilde etkilediği görülmüştür. Ayrıca çalışmamızda GNRI ile bir diğer güvenilir değerlendirme sistemi olan MIS ile karşılaştırmasında da GNRI’ nın güvenilir bir değerlendirme sistemi olduğu görülmüştür.
References
- 1. SÜLEYMANLAR G. Kronik böbrek hastalığı ve yetmezliği: tanımı, evreleri ve epidemiyolojisi. 2007;3(38):1-7.
- 2. Sanyaolu A, Okorie C, Annan R, Turkey H, Akhtar N, Gray F, et al. Epidemiology and management of chronic renal failure: a global public health problem. 2018;1(1):11-6.
- 3. Süleymanlar G, Utaş C, Arinsoy T, Ateş K, Altun B, Altiparmak MR, et al. A population-based survey of Chronic REnal Disease In Turkey—the CREDIT study. 2010;26(6):1862-71
- 4. Registry of the Nephrology, Dialysis And Transplantation in Turkey Regıstry 2016
- 5. Yenice M. Kronik Böbrek Yetmezliği. Arık N (Editör). Deniz matbaacılık, 1.baskı, 2001; 212-24.
- 6. 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. 2008;73(4):391-8.
- 7. Yamada K, Furuya R, Takita T, Maruyama Y, Yamaguchi Y, Ohkawa S, et al. Simplified nutritional screening tools for patients on maintenance hemodialysis. 2008;87(1):106-13.
- 8. Kobayashi I, Ishimura E, Kato Y, Okuno S, Yamamoto T, Yamakawa T, et al. Geriatric Nutritional Risk Index, a simplified nutritional screening index, is a significant predictor of mortality in chronic dialysis patients. 2010;25(10):3361-5.
- 9. Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent J-P, Nicolis I, et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. 2005;82(4):777-83.
- 10. Kiuchi A, Ohashi Y, Tai R, Aoki T, Mizuiri S, Ogura T, et al. Association between low dietary protein intake and geriatric nutrition risk index in patients with chronic kidney disease: A retrospective single-center cohort study. 2016;8(10):662.
- 11. Kuo I, Huang J-C, Wu P-Y, Chen S-C, Chang J-M, Chen H-CJN. A low geriatric nutrition risk index is associated with progression to dialysis in patients with chronic kidney disease. 2017;9(11):1228.
- 12. Chung S, Koh ES, Shin SJ, Park CW. Malnutrition in patients with chronic kidney disease. Open Journal of Internal Medicine. 2012;2(02):89.
- 13. Park JH, Kim SB, Shin HS, Jung YS, Rim H. Geriatric nutritional risk index may be a significant predictor of mortality in Korean hemodialysis patients: a single center study. Therapeutic Apheresis Dialysis 2012;16(2):121-6.
- 14. Nguyen‐Khoa T, Massy ZA, De Bandt JP, Kebede M, Salama L, Lambrey G, et al. Oxidative stress and haemodialysis: role of inflammation and duration of dialysis treatment. 2001;16(2):335-40.
- 15. Stenvinkel P, Heimbürger O, Lindholm B, Kaysen GA, Bergström J. Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrology Dialysis Transplantation. 2000;15(7):953-60.
- 16. Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH. A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. American journal of kidney diseases. 2001;38(6):1251-63.
- 17. Ülger Z, Halil M, Kalan I, Yavuz BB, Cankurtaran M, Güngör E, et al. Comprehensive assessment of malnutrition risk and related factors in a large group of community-dwelling older adults. Clinical Nutrition. 2010;29(4):507-11.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Article |
| Authors | |
| Publication Date | December 27, 2022 |
| Acceptance Date | November 15, 2022 |
| Published in Issue | Year 2022 Volume: 6 Issue: 3 |
