Geriatric nutritional risk index predicts incident kidney failure with replacement therapy among patients with biopsy-proven diabetic nephropathy

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice Pub Date : 2025-08-23 DOI:10.1016/j.diabres.2025.112433

Takayuki Uemura , Masatoshi Nishimoto , Masahiro Eriguchi , Hiroyuki Tamaki , Hikari Tasaki , Riri Furuyama , Takaaki Kosugi , Akiko Itano , Katsuhiko Morimoto , Masaru Matsui , Ken-ichi Samejima , Kazuhiko Tsuruya

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Abstract

Aims

The geriatric nutritional risk index (GNRI) is a predictor for kidney prognosis. However, malnutrition can lead to overestimation of creatinine-based estimated glomerular filtration rate (eGFR), particularly in diabetic nephropathy (DN). This study examined whether GNRI was associated with kidney prognosis after accounting for muscle mass-independent kidney function markers in DN.

Methods

This observational study included patients with biopsy-proven DN at Nara Medical University Hospital. The exposure was GNRI at the time of kidney biopsy. The outcome was kidney failure with replacement therapy (KFRT). Multivariable Cox regression analyses were performed to examine the association of GNRI with KFRT.

Results

Among 405 patients were categorized by GNRI cutoff of 98. During a median follow-up of 6.7 years, 99 patients developed KFRT. Lower GNRI was associated with higher incidence of KFRT after adjustment for clinical and kidney histopathological factors (hazard ratio [95 % confidence interval]: 3.13 [1.74–5.61]). The association remained robust even after additional adjustment for muscle mass-independent kidney function markers (serum β2-microglobulin or muscle mass-adjusted eGFR).

Conclusions

Among patients with DN, lower GNRI was associated with incident KFRT even after adjustment for muscle mass-independent kidney function markers. Further research is warranted to clarify whether nutritional improvement can attenuate kidney function decline.

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在活检证实的糖尿病肾病患者中，老年营养风险指数预测替代治疗后发生肾衰竭

目的老年营养风险指数（GNRI）是肾脏预后的预测指标。然而，营养不良可导致高估基于肌酐的肾小球滤过率（eGFR），特别是在糖尿病肾病（DN）中。本研究在考虑DN中与肌肉质量无关的肾功能标志物后，研究了GNRI是否与肾脏预后相关。方法本观察性研究纳入奈良医科大学医院活检证实的DN患者。肾活检时暴露为GNRI。结果是肾衰竭与替代治疗（KFRT）。采用多变量Cox回归分析来检验GNRI与KFRT的关系。结果405例患者的GNRI分界点为98例。在中位随访6.7年期间，99例患者发生KFRT。经临床和肾脏组织病理学因素校正后，较低的GNRI与较高的KFRT发生率相关（风险比[95%可信区间]:3.13[1.74-5.61]）。即使在对与肌肉质量无关的肾功能标志物（血清β2微球蛋白或肌肉质量调节的eGFR）进行额外调整后，这种相关性仍然很强。结论在DN患者中，即使调整了与肌肉质量无关的肾功能指标，较低的GNRI也与KFRT的发生有关。需要进一步的研究来阐明营养改善是否可以减轻肾功能下降。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes research and clinical practice 医学-内分泌学与代谢

CiteScore

10.30

自引率

3.90%

发文量

862

审稿时长

32 days

期刊介绍： Diabetes Research and Clinical Practice is an international journal for health-care providers and clinically oriented researchers that publishes high-quality original research articles and expert reviews in diabetes and related areas. The role of the journal is to provide a venue for dissemination of knowledge and discussion of topics related to diabetes clinical research and patient care. Topics of focus include translational science, genetics, immunology, nutrition, psychosocial research, epidemiology, prevention, socio-economic research, complications, new treatments, technologies and therapy.