Geriatric nutrition risk index is associated with renal progression, cardiovascular events and all-cause mortality in chronic kidney disease

  • Jiachuan Xiong
  • Min Wang
  • Jinwei Wang
  • Ke Yang
  • Yu Shi
  • Jingbo Zhang
  • Bo Zhang
  • Luxia Zhang
  • Jinghong ZhaoEmail author
  • The Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE)
Original Article



Malnutrition is common and associated with poor outcomes in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Recently, the geriatric nutritional risk index (GNRI) was reported as a novel tool for evaluating nutritional status. However, the association between GNRI and renal outcome, cardiovascular (CVD) events, and mortality in patients with CKD remains unclear.


A prospective cohort study with adult patients with CKD stages 1–4 was conducted at 39 centers around China starting in 2011. Patients were divided into quartiles (Q1, Q2, Q3, and Q4) according to their GNRI category.


A total of 2791 CKD patients within a median follow-up of 4.38 years were included. A low GNRI quartile was independently associated with progression to ESRD, CVD events, and overall mortality. Compared to that in the Q1 group (the reference group), belonging to a higher GNRI quartile significantly reduced the risk of progression to ESRD in the crude and multivariate-adjusted models. Moreover, a significant inverse association was found between those in the high GNRI quartiles and overall mortality among patients with CKD (HR 0.25; 95% CI 0.15–0.43; p = 0.0007, Q4 vs. Q1) after multivariate adjustment. In addition, there was also a significant association between GNRI and CVD events (HR 0.57; 95% CI 0.39–0.84; p = 0.005, Q4 vs. Q1). Moreover, after adjusting for other confounders, only the Q3 group remained significantly fewer CVD events (HR 0.44; 95% CI 0.19–0.98; p = 0.04).


These findings suggest that GNRI might be a useful prognostic tool for patients with CKD.


Geriatric nutritional risk index Chronic kidney disease End-stage renal disease Mortality Cardiovascular disease 



The authors would like to express gratitude to every member of the C-STRIDE group for their close collaboration. The Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE) Collaborators: Peking University First Hospital: Ming-Hui Zhao, Luxia Zhang; the Affiliated Hospital of Hubei Traditional Chinese Medical College: Xiaoqin Wang, Jun Yuan; the Xiangya Hospital of Central South University: Qiaoling Zhou, Qiongjing Yuan; General Hospital of Ningxia Medical University: Menghua Chen, Xiaoling Zhou; the Second Hospital of Hebei Medical University: Shuxia Fu, Shaomei Li; Guizhou Provincial People’s Hospital: Yan Zha, Rongsai Huang; the First Affiliated Hospital of Zhengzhou University: Zhangsuo Liu, JunJun Zhang; Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital: Li Wang, Lei Pu; the First Affiliated Hospital of Xinjiang University of Medicine: Jian Liu, Suhua Li; Peking University Shenzhen Hospital: Zuying Xiong, Wei Liang; Xinqiao Hospital: Jinghong Zhao, Jiao Mu; the Second Affiliated Hospital of Kunming Medical College: Xiyan Lian, Yunjuan Liao; the First Affiliated Hospital of Chongqing University of Medicine: Hua Gan, Liping Liao; Shandong Provincial Hospital: Rong Wang, Zhimei Lv; the First Affiliated Hospital of Guangxi University of Medicine: Yunhua Liao, Ling Pan; the First Affiliated Hospital of the Medical College, Shihezi University: Xiaoping Yang, Zhifeng Lin; Yuxi City People’s Hospital: Zongwu Tong, Yun Zhu; Beilun People’s Hospital in Ningbo: Qiang He, Fuquan Wu; the Second Affiliated Hospital of Tianjin University of Medicine: Rong Li, Kai Rong; the First Affiliated Hospital of Baotou Medical College: Caili Wang, Yanhui Zhang; Peking University Third Hospital: Yue Wang, Wen Tang; Beijing Hospital of Ministry of Health: Hua Wu, Ban Zhao; the Second Hospital of Shanxi University of Medicine: Rongshan Li, Lihua Wang; Shengjing Hospital of China Medical University: Detian Li, Feng Du; the First Affiliated Hospital of Anhui University of Medicine: Yonggui Wu, Wei Zhang; Tianjin Medical University General Hospital: Shan Lin, Pengcheng Xu; the First Affiliated Hospital of Dalian University of Medicine: Hongli Lin; Shandong University Qilu Hospital: Zhao Hu, Fei Pei; the Affiliated Hospital of Hebei University: Haisong Zhang, Yan Gao; Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine: Luying Sun, Xia Li; Chifeng Second Hospital: Wenke Wang, Fengling Lv; the Second Affiliated Hospital of Anhui University of Medicine: Deguang Wang, Xuerong Wang; Qianfoshan Hospital: Dongmei Xu, Lijun Tang; China Rehabilitation Research Center, Beijing Boai Hospital: Yingchun Ma, Tingting Wang; West China Hospital of Sichuan University: Ping Fu, Tingli Wang; the First Affiliated Hospital with Nanjing Medical University: Changying Xing, Chengning Zhang; Minhang Central Hospital: Xudong Xu, Haidong He; the Second Affiliated Hospital of Chongqing University of Medicine: Xiaohui Liao, Shuqin Xie; the Affiliated Hospital of Chengde Medical Colledge: Guicai Hu, Lan Huang.

Compliance with ethical standards

Conflict of interest

All the authors declared no competing interests.

Ethical approval

The study was approved by the Ethics Committee of Peking University First Hospital and was in adherence with the Declaration of Helsinki.


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Copyright information

© Italian Society of Nephrology 2019

Authors and Affiliations

  • Jiachuan Xiong
    • 1
  • Min Wang
    • 2
  • Jinwei Wang
    • 3
    • 4
  • Ke Yang
    • 1
  • Yu Shi
    • 1
  • Jingbo Zhang
    • 1
  • Bo Zhang
    • 1
  • Luxia Zhang
    • 3
    • 4
  • Jinghong Zhao
    • 1
    Email author
  • The Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE)
  1. 1.Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Kidney Center of PLA, Xinqiao HospitalArmy Medical University (Third Military Medical University)ChongqingPeople’s Republic of China
  2. 2.Department of Otorhinolaryngology and Head-Neck Surgery, Xinqiao HospitalThird Military Medical UniversityChongqingPeople’s Republic of China
  3. 3.Renal Division, Department of MedicinePeking University First HospitalBeijingChina
  4. 4.Peking University Institute of Nephrology, Peking University Health Science CenterBeijingChina

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