中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (10): 813-817.doi: 10.3969/j.issn.1671-4091.2025.10.005

• 临床研究 • 上一篇    下一篇

老年营养风险指数与慢性肾脏病进展的相关性研究

赵 雪   闫梦瑶   高竹梅    梁珊珊    蒋红利    魏丽敏   

  1. 710061 西安，西安交通大学第一附属医院1重症肾脏病・血液净化科科 3输血科
    710003 西安，2西安市中心医院肾脏内科
  • 收稿日期:2024-12-05 修回日期:2025-07-22 出版日期:2025-10-12 发布日期:2025-10-12
  • 通讯作者: 魏丽敏 E-mail:weilimin0924@163.com
  • 基金资助:
    陕西省重点研发计划一般项目(2024SF-YBXM-190)；陕西省重点研发计划一般项目(2023-YBSF-239)

Geriatric nutritional risk index is associated with renal progression in patients with chronic kidney disease

ZHAO Xue, YAN Meng-yao, GAO Zhu-mei, LIANG Shan-shan, JIANG Hong-li, WEI Li-min   

  1. Department of Critical Care Nephrology and Blood Purification, 3Department of Transfusion, the First Affiliated Hospital of Xi’an Jiaotong University. Xi’an 710061, China; 2Department of Nephrology, Xi'an Central Hospital, Xi’an 710003, China
  • Received:2024-12-05 Revised:2025-07-22 Online:2025-10-12 Published:2025-10-12
  • Contact: 710061 西安，西安交通大学第一附属医院1重症肾脏病・血液净化科 E-mail:weilimin0924@163.com

摘要： 目的  探讨老年营养风险指数(geriatric nutritional risk index，GNRI)与慢性肾脏病(chronic kidney disease，CKD)患者肾功能损害进展之间的关联。 方法  对DRYAD公开数据库中CKD-ROUTE研究进行二次分析。根据患者基线临床资料计算GNRI，分为高GNRI组(GNRI≥98)和低GNRI组(GNRI＜98)。采用COX比例风险模型对GNRI与CKD进展[估算肾小球滤过率(estimated glomerular filtration rate，eGFR)下降超过50%或开始肾脏替代治疗]之间关联进行评估，并进行亚组分析。 结果  共纳入996例CKD G2～5患者，基线GNRI平均水平(97.28±10.28)，高GNRI组患者562例(56.4%)，低GNRI组434例(43.6%)。低GNRI组CKD患者年龄(t= -4.245；P＜0.001)、高血压(Z=10.433；P=0.001)、糖尿病(Z=31.137；P＜0.001)和心血管病史占比(Z=14.934；P＜0.001)及基线出现血尿(t=40.894； P＜0.001)和蛋白尿(t=102.023；P＜0.001)的比例均高于高GNRI组，基线eGFR(t= -7.859；P＜0.001)、血红蛋白(t=14.368；P＜0.001)和白蛋白(t=35.454；P＜0.001)的水平低于高GNRI组。264例患者出现CKD进展，累积发生率为26.5%。COX回归分析显示以高GNRI组为参照，低GNRI组患者发生CKD进展的危险比为1.563(95% CI:1.166～2.095，P＜0.001)。亚组分析显示低GNRI与CKD进展风险增加之间的关联在不同性别(HR=1.477，95% CI：1.035～2.107，P=0.032)、有无2型糖尿病(HR =1.793，95% CI：1.154～2.786，P=0.009)、有无心血管病史(HR =1.413，95% CI：1.010～1.978，P=0.044)、不同血红蛋白水平(HR =1.557，95% CI：1.144～2.119，P=0.005)及收缩压水平(HR =1.578，95% CI：1.004～2.479，P=0.048)中稳定存在。  结论  低GNRI是非透析CKD患者肾功能损害进展的独立危险因素，定期筛查并进行合理营养干预有助于改善其预后。

关键词: 慢性肾脏病, 老年营养风险指数：肾损害进展, 影响因素

Abstract: Objective  To investigate the association between the Geriatric Nutritional Risk Index (GNRI) and the progression of renal impairment in patients with chronic kidney disease (CKD).  Methods  A secondary analysis was conducted using data from the CKD-ROUTE study available in the DRYAD open database. Based on baseline clinical data, patients were categorized into a high GNRI group (GNRI ≥ 98) and a low GNRI group (GNRI<98). A Cox proportional hazards model was used to evaluate the association between GNRI and CKD progression, defined as a ≥50% decline in estimated glomerular filtration rate (eGFR) or initiation of renal replacement therapy. Subgroup analyses were also performed.  Results   A total of 996 patients with CKD stages G2 to G5 were included. The mean baseline GNRI was 97.28±10.28. The high GNRI group consisted of 562 patients (56.4%), while the low GNRI group had 434 patients (43.6%). Compared to the high GNRI group, the low GNRI group had older age (t =-4.245; P <0.001), higher prevalence of hypertension (Z=10.433; P=0.001), diabetes (Z=31.137; P<0.001), and cardiovascular disease (Z=14.934; P< 0.001), as well as higher rates of baseline hematuria (t =40.894; P<0.001) and proteinuria (t =102.023; P< 0.001). However, baseline eGFR (t =-7.859; P <0.001), hemoglobin (t =14.368; P <0.001), and albumin levels (t =35.454; P<0.001) were lower in the low GNRI group. CKD progression occurred in 264 patients, with a cumulative incidence of 26.5%. Cox regression analysis showed that, compared to the high GNRI group, the low GNRI group had a hazard ratio of 1.563 (95% CI: 1.166～2.095, P<0.001) for CKD progression. Subgroup analysis revealed that the association between low GNRI and increased risk of CKD progression was consistent across different genders (HR=1.477, 95% CI: 1.035～2.107, P=0.032), presence or absence of type 2 diabetes (HR =1.793, 95% CI: 1.154～2.786, P =0.009), history of cardiovascular disease (HR =1.413,     95% CI: 1.010～1.978, P=0.044), and varying levels of hemoglobin (HR =1.557, 95% CI: 1.144～2.119, P= 0.005) and systolic blood pressure (HR =1.578, 95% CI: 1.004～2.479, P =0.048).  Conclusion  Low GNRI is an independent risk factor for the progression of renal impairment in non-dialysis CKD patients. Regular screening and appropriate nutritional interventions may help improve their prognosis. 

Key words: Chronic kidney disease, Geriatric nutritional risk index, Progression of renal impairment, Risk factors

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