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Association of the nutritional risk index for Japanese hemodialysis patients with long-term mortality: The Q-Cohort Study

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Abstract

Background

Protein-energy wasting (PEW) is a risk factor for mortality in patients undergoing hemodialysis. Recently, a nutritional risk index for Japanese hemodialysis patients (NRI-JH) has been proposed as a surrogate index of PEW. However, no study has determined the association of the NRI-JH with long-term mortality in patients undergoing hemodialysis. Furthermore, the validity of the NRI-JH has not been confirmed.

Methods

In total, 3046 patients undergoing hemodialysis and registered in the Q-Cohort Study were followed up for 10 years. The NRI-JH was calculated on the basis of body mass index and serum levels of albumin, total cholesterol, and creatinine. The patients were divided into four groups according to the NRI-JH scores: 0–3 (G1, n = 1343), 4–7 (G2, n = 1136), 8–10 (G3, n = 321), and 11–13 (G4, n = 246). We examined the association between the NRI-JH and the 4-year and 10-year risks of all-cause, cardiovascular, and infection-related deaths using the Cox proportional hazards model.

Results

During the follow-up period, 647 patients died during the first 4 years, and 1503 patients died within 10 years. The 4-year prognosis was analyzed and compared with the lowest NRI-JH score group. Multivariable-adjusted hazard ratios (95% confidence intervals) for all-cause death were 1.93 (1.57–2.38), 2.68 (2.05–3.50), and 3.16 (2.40–4.16) in the G2, G3, and G4 groups, respectively. Similarly, a higher NRI-JH score was associated with an increased risk of cardiovascular and infection-related deaths.

Conclusion

A higher NRI-JH score was associated with an increased risk of long-term mortality in patients undergoing maintenance hemodialysis.

Trial registration

The study protocol was registered in the University Hospital Medical Information Network (UMIN) clinical trial registry (UMIN ID: 000000556).

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References

  1. Ikizler TA, Cano NJ, Franch H, Fouque D, Himmelfarb J, Kalantar-Zadeh K, et al. Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International society of renal nutrition and metabolism. Kidney Int. 2013;84(6):1096–107.

    Article  CAS  Google Scholar 

  2. 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. Kidney Int. 2008;73(4):391–8.

    Article  CAS  Google Scholar 

  3. Koppe L, Fouque D, Kalantar-Zadeh K. Kidney cachexia or protein-energy wasting in chronic kidney disease: facts and numbers. J Cachexia Sarcopenia Muscle. 2019;10(3):479–84.

    Article  Google Scholar 

  4. Carrero JJ, Thomas F, Nagy K, Arogundade F, Avesani CM, Chan M, et al. Global prevalence of protein-energy wasting in kidney disease: a meta-analysis of contemporary observational studies from the international society of renal nutrition and metabolism. J Ren Nutr. 2018;28(6):380–92.

    Article  Google Scholar 

  5. Rambod M, Bross R, Zitterkoph J, Benner D, Pithia J, Colman S, et al. Association of malnutrition-inflammation score with quality of life and mortality in hemodialysis patients: a 5-year prospective cohort study. Am J Kidney Dis. 2009;53(2):298–309.

    Article  Google Scholar 

  6. de Mutsert R, Grootendorst DC, Axelsson J, Boeschoten EW, Krediet RT, Dekker FW. Excess mortality due to interaction between protein-energy wasting, inflammation and cardiovascular disease in chronic dialysis patients. Nephrol Dial Transpl. 2008;23(9):2957–64.

    Article  Google Scholar 

  7. Kanda E, Kato A, Masakane I, Kanno Y. A new nutritional risk index for predicting mortality in hemodialysis patients: nationwide cohort study. PLoS ONE. 2019;14(3):e0214524.

    Article  CAS  Google Scholar 

  8. Yamada S, Taniguchi M, Tokumoto M, Yoshitomi R, Yoshida H, Tatsumoto N, et al. Modified creatinine index and the risk of bone fracture in patients undergoing hemodialysis: the Q-cohort study. Am J Kidney Dis. 2017;70(2):270–80.

    Article  CAS  Google Scholar 

  9. Tanaka S, Ninomiya T, Taniguchi M, Fujisaki K, Tokumoto M, Hirakata H, et al. Comparison of oral versus intravenous vitamin D receptor activator in reducing infection-related mortality in hemodialysis patients: the Q-cohort study. Nephrol Dial Transpl. 2016;31(7):1152–60.

    Article  CAS  Google Scholar 

  10. Eriguchi R, Taniguchi M, Ninomiya T, Hirakata H, Fujimi S, Tsuruya K, et al. Hyporesponsiveness to erythropoiesis-stimulating agent as a prognostic factor in Japanese hemodialysis patients: the Q-cohort study. J Nephrol. 2015;28(2):217–25.

    Article  CAS  Google Scholar 

  11. Tanaka S, Ninomiya T, Hiyamuta H, Taniguchi M, Tokumoto M, Masutani K, et al. Apparent treatment-resistant hypertension and cardiovascular risk in hemodialysis patients: ten-year outcomes of the Q-cohort study. Sci Rep. 2019;9(1):1043.

    Article  Google Scholar 

  12. Arase H, Yamada S, Hiyamuta H, Taniguchi M, Tokumoto M, Tsuruya K, et al. Modified creatinine index and risk for long-term infection-related mortality in hemodialysis patients: ten-year outcomes of the Q-cohort study. Sci Rep. 2020;10(1):1241.

    Article  CAS  Google Scholar 

  13. Nakano T, Hiyamuta H, Yotsueda R, Tanaka S, Taniguchi M, Tsuruya K, et al. Higher cholesterol level predicts cardiovascular event and inversely associates with mortality in hemodialysis patients: 10-year outcomes of the Q-cohort study. Ther Apher Dial. 2020;24(4):431–8.

    Article  CAS  Google Scholar 

  14. Kazama JJ. Japanese society of dialysis therapy treatment guidelines for secondary hyperparathyroidism. Ther Apher Dial. 2007;11(Suppl 1):S44–7.

    Article  CAS  Google Scholar 

  15. Payne RB, Little AJ, Williams RB, Milner JR. Interpretation of serum calcium in patients with abnormal serum proteins. Br Med J. 1973;4(5893):643–6.

    Article  CAS  Google Scholar 

  16. Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transpl. 2013;48(3):452–8.

    Article  CAS  Google Scholar 

  17. Carrero JJ, Stenvinkel P, Cuppari L, Ikizler TA, Kalantar-Zadeh K, Kaysen G, et al. Etiology of the protein-energy wasting syndrome in chronic kidney disease: a consensus statement from the international society of renal nutrition and metabolism (ISRNM). J Ren Nutr. 2013;23(2):77–90.

    Article  Google Scholar 

  18. Sabatino A, Regolisti G, Karupaiah T, Sahathevan S, Singh BKS, Khor BH, et al. Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on hemodialysis. Clin Nutr. 2017;36(3):663–71.

    Article  CAS  Google Scholar 

  19. Kovesdy CP, Kalantar-Zadeh K. Why is protein-energy wasting associated with mortality in chronic kidney disease? Semin Nephrol. 2009;29(1):3–14.

    Article  CAS  Google Scholar 

  20. Pedersen BK, Febbraio MA. Muscles, exercise and obesity: skeletal muscle as a secretory organ. Nat Rev Endocrinol. 2012;8(8):457–65.

    Article  CAS  Google Scholar 

  21. Carrero JJ, Nakashima A, Qureshi AR, Lindholm B, Heimburger O, Barany P, et al. Protein-energy wasting modifies the association of ghrelin with inflammation, leptin, and mortality in hemodialysis patients. Kidney Int. 2011;79(7):749–56.

    Article  CAS  Google Scholar 

  22. Campbell GA, Patrie JT, Gaylinn BD, Thorner MO, Bolton WK. Oral ghrelin receptor agonist mk-0677 increases serum insulin-like growth factor 1 in hemodialysis patients: a randomized blinded study. Nephrol Dial Transpl. 2018;33(3):523–30.

    Article  CAS  Google Scholar 

  23. van Zuijdewijn CLDR, ter Wee PM, Chapdelaine I, Bots ML, Blankestijn PJ, van den Dorpel MA, et al. A comparison of 8 nutrition-related tests to predict mortality in hemodialysis patients. J Ren Nutr. 2015;25(5):412–9.

    Article  Google Scholar 

  24. Kalantar-Zadeh K, Abbott KC, Salahudeen AK, Kilpatrick RD, Horwich TB. Survival advantages of obesity in dialysis patients. Am J Clin Nutr. 2005;81(3):543–54.

    Article  CAS  Google Scholar 

  25. Kalantar-Zadeh K, Cano NJ, Budde K, Chazot C, Kovesdy CP, Mak RH, et al. Diets and enteral supplements for improving outcomes in chronic kidney disease. Nat Rev Nephrol. 2011;7(7):369–84.

    Article  CAS  Google Scholar 

  26. Iseki K, Yamazato M, Tozawa M, Takishita S. Hypocholesterolemia is a significant predictor of death in a cohort of chronic hemodialysis patients. Kidney Int. 2002;61(5):1887–93.

    Article  Google Scholar 

  27. Huang CX, Tighiouart H, Beddhu S, Cheung AK, Dwyer JT, Eknoyan G, et al. Both low muscle mass and low fat are associated with higher all-cause mortality in hemodialysis patients. Kidney Int. 2010;77(7):624–9.

    Article  Google Scholar 

  28. Walther CP, Carter CW, Low CL, Williams P, Rifkin DE, Steiner RW, et al. Interdialytic creatinine change versus predialysis creatinine as indicators of nutritional status in maintenance hemodialysis. Nephrol Dial Transpl. 2012;27(2):771–6.

    Article  CAS  Google Scholar 

  29. Young HML, March DS, Graham-Brown MPM, Jones AW, Curtis F, Grantham CS, et al. Effects of intradialytic cycling exercise on exercise capacity, quality of life, physical function and cardiovascular measures in adult haemodialysis patients: a systematic review and meta-analysis. Nephrol Dial Transpl. 2018;33(8):1436–45.

    Article  Google Scholar 

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Acknowledgements

The authors thank the following investigators at the participating institutions. We thank the participants in the Q-Cohort Study, the members of the Society for the Study of Kidney Disease, and all staff members of the institutions participating in the study. The following personnel (institutions) participated in the study: Takashi Ando (Hakozaki Park Internal Medicine Clinic), Takashi Ariyoshi (Ariyoshi Clinic), Koichiro Goto (Goto Clinic), Fumitada Hattori (Nagao Hospital), Harumichi Higashi (St. Mary’s Hospital), Tadashi Hirano (Hakujyuji Hospital), Kei Hori (Munakata Medical Association Hospital), Takashi Inenaga (Ekisaikai Moji Hospital), Hidetoshi Kanai (Kokura Memorial Hospital), Shigemi Kiyama (Kiyama Naika), Tetsuo Komota (Komota Clinic), Hiromasa Kuma (Kuma Clinic), Toshiro Maeda (Kozenkai-Maeda Hospital), Junichi Makino (Makino Clinic), Dai Matsuo (Hirao Clinic), Chiaki Miishima (Miishima Naika Clinic), Koji Mitsuiki (Japanese Red Cross Fukuoka Hospital), Kenichi Motomura (Motomura Naika Clinic), Sadatoshi Nakamura and Hidetoshi Nakamura (Kokura Daiichi Hospital), Koichi Nakashima (Ohashi Internal Circulatory Clinic), Nobumitsu Okita (Shiroishi Kyoritsu Hospital), Shinichiro Osato (Osato Jin Clinic), Sakura Sakamoto (Fujiyamato Spa Hospital), Keiko Shigematsu (Shigematsu Clinic), Kazumasa Shimamatsu (Shimamatsu Naika Iin), Yoshito Shogakiuchi (Shin-Ai Clinic), Hiroaki Takamura (Hara Hospital), Kazuhito Takeda (Iizuka Hospital), Asuka Terai (Chidoribashi Hospital), Hideyoshi Tanaka (Mojiko-Jin Clinic), Suguru Tomooka (Hakozaki Park Internal Medicine Clinic), Jiro Toyonaga (Fukuoka Renal Clinic), Hiroshi Tsuruta (Steel Memorial Yawata Hospital), Ryutaro Yamaguchi (Shiseikai Hospital), Taihei Yanagida (Saiseikai Yahata General Hospital), Tetsuro Yanase (Yanase Internal Medicine Clinic), Tetsuhiko Yoshida (Hamanomachi Hospital), Takahiro Yoshimitsu (Gofukumachi Kidney Clinic, Harasanshin Hospital), and Koji Yoshitomi (Yoshitomi Medical Clinic). We thank Eva Lasic, PhD, from Edanz Group (https://en-author-services.edanzgroup.com/ac) for editing a draft of this manuscript.

Funding

The Q-Cohort Study was supported by The Kidney Foundation, Japan (H19 JKFB 07-13, H20 JKFB 08-8, and H23 JKFB 11-11) and The Japan Dialysis Outcome Research Foundation (H19-076-02 and H20-003) without restriction on publications.

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Authors and Affiliations

  1. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan

    Sho Shimamoto, Shunsuke Yamada, Hiroto Hiyamuta, Hokuto Arase, Toshiaki Nakano & Takanari Kitazono

  2. Fukuoka Renal Clinic, Fukuoka, Japan

    Masatomo Taniguchi

  3. Department of Nephrology, Nara Medical University, Nara, Japan

    Kazuhiko Tsuruya

Authors
  1. Sho Shimamoto
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  2. Shunsuke Yamada
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  3. Hiroto Hiyamuta
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  4. Hokuto Arase
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  5. Masatomo Taniguchi
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  6. Kazuhiko Tsuruya
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  7. Toshiaki Nakano
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  8. Takanari Kitazono
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Contributions

SS: Conceptualization, Methodology, Formal analysis, Visualization, Writing- Original draft preparation. SY: Conceptualization, Validation, Writing- Reviewing and Editing. HH: Investigation, Data curation, Writing- Reviewing and Editing. HA: Writing- Reviewing and Editing. MT: Data curation, Writing- Reviewing and Editing. KT: Project administration. TN: Project administration, Writing- Reviewing and Editing. TK: Supervision.

Corresponding author

Correspondence to Toshiaki Nakano.

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Conflict of interest

The authors declare that they have no relevant financial interests.

Ethical approval

The study protocol was approved by the Clinical Research Ethics Committee of the Institutional Review Board at Kyushu University (Approval Number: 20–31). The present study was performed according to the Ethics of Clinical Research (Declaration of Helsinki).

Informed consent

All of the patients provided written informed consent at the start of the study.

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Shimamoto, S., Yamada, S., Hiyamuta, H. et al. Association of the nutritional risk index for Japanese hemodialysis patients with long-term mortality: The Q-Cohort Study. Clin Exp Nephrol 26, 59–67 (2022). https://doi.org/10.1007/s10157-021-02124-6

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  • DOI: https://doi.org/10.1007/s10157-021-02124-6

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