Abstract: bjective   To evaluate the relationship between annual changes in geriatric nutritional risk index (ΔGNRI) and all-cause mortality and cardiovascular mortality in elderly patients undergoing maintenance hemodialysis (MHD).  Methods   A total of 398 elderly patients who received hemodialysis in our hospital from October 2010 to July 2013 were retrospectively analyzed. Demographic and clinical data of the patients were collected, and ΔGNRI was calculated from the difference between GNRI at baseline and the value after one year. Patients were then divided into four groups: G1 group, GNRI ≥91.2 and ΔGNRI ≥0%; G2 group: GNRI ≥91.2 and ΔGNRI < 0%; G3 group, GNRI ＜91.2 and ΔGNRI ≥0%; G4 group, GNRI ＜91.2 and ΔGNRI ＜0%. The correlation between ΔGNRI and baseline GNRI was examined. The differences in all-cause mortality and cardiovascular mortality among the four groups were analyzed. The adjusted hazard ratio (aHR) and 95% confidence interval (CI) of mortality were calculated by multivariate Cox regression model.  Results  The median ΔGNRI was 0.16 (0.07, 0.46). ΔGNRI was negatively correlated with baseline GNRI  (ρ=0.199, P=0.005). During a follow-up period of 3.7 (1.9, 6.9) years, 108 patients died. Baseline GNRI < 91.2 [aHR 95% CI: 2.59 (1.54~4.33), P<0.001] and ΔGNRI < 0% [aHR 95% CI: 2.33 (1.32~4.32), P=0.003] were the independent predictors for all-cause mortality. The 10-year survival rates in G1, G2, G3 and G4 groups were 69.8%, 43.2%, 39.9% and 19.2%, respectively (log rank test: χ2=18.654, P<0.001). With G1 group as the reference, the aHR for all-cause mortality in G4 group was 3.88 (95% CI : 1.62~9.48, P=0.003).  Conclusions Annual changes in GNRI (ΔGNRI) were negatively correlated with baseline, and can accurately predict all-cause mortality and cardiovascular mortality in MHD patients.

Key words: The geriatric nutritional risk index, Maintenance hemodialysis, Risk of death, Dynamic evaluation