PROGNOSTIC VALUE OF CONTROLLING NUTRITIONAL STATUS SCORE AND PROGNOSTIC NUTRITIONAL INDEX FOR ALL-CAUSE MORTALITY IN PATIENTS WITH CKD: THE FUKUOKA KIDNEY DISEASE REGISTRY STUDY

 

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https://storage.unitedwebnetwork.com/files/1099/5fd15e35aa6310bd3c692c6b791b47a7.pdf
PROGNOSTIC VALUE OF CONTROLLING NUTRITIONAL STATUS SCORE AND PROGNOSTIC NUTRITIONAL INDEX FOR ALL-CAUSE MORTALITY IN PATIENTS WITH CKD: THE FUKUOKA KIDNEY DISEASE REGISTRY STUDY

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Naoki
Haruyama
Naoki Haruyama nharuyama118@gmail.com NHO Kyushu Medical Center Division of Nephrology, Department of Internal Medicine Fukuoka Japan *
Masaru Nakayama nakayama51224@gmail.com NHO Kyushu Medical Center Division of Nephrology, Department of Internal Medicine Fukuoka Japan -
Shigeru Tanaka sigella1975@gmail.com Kyushu University Department of Epidemiology and Public Health, Graduate School of Medical Sciences Fukuoka Japan -
Susumu Tsuda daatsuuu@gmail.com NHO Kyushu Medical Center Division of Nephrology, Department of Internal Medicine Fukuoka Japan -
Ryota Yoshitomi ryoshitomi.1130@gmail.com NHO Kyushu Medical Center Division of Nephrology, Department of Internal Medicine Fukuoka Japan -
Akiko Fukui akiko-march1119@hotmail.co.jp NHO Kyushu Medical Center Division of Nephrology, Department of Internal Medicine Fukuoka Japan -
Kazuhiko Tsuruya tsuruya@naramed-u.ac.jp Nara Medical University Department of Nephrology Kashihara Japan -
Shunsuke Yamada yamada.shunsuke.944@m.kyushu-u.ac.jp Kyushu University Department of Medicine and Clinical Science, Graduate School of Medical Sciences Fukuoka Japan -
Toshiaki Nakano nakano.toshiaki.455@m.kyushu-u.ac.jp Kyushu University Department of Medicine and Clinical Science, Graduate School of Medical Sciences Fukuoka Japan -
 
 
 
 
 
 

The controlling nutritional status (CONUT) score and prognostic nutritional index (PNI) are objective and convenient screening tools for the early detection of poor immune/nutritional status. Previous studies have shown that these indices are predictors of all-cause mortality in patients with chronic kidney disease (CKD). However, their utility for the prediction of mortality beyond traditional cardiovascular (CV) risk factors has not been evaluated. To determine whether the addition of the CONUT score and PNI to traditional CV risk factors improves the prediction of all-cause mortality in a prospective cohort of patients with CKD.

We studied 2,773 patients with CKD who were not undergoing dialysis. The CONUT score was calculated using the lymphocyte count, serum albumin concentration, and serum total cholesterol concentration, and the patients were allocated to low- (CONUT score = 0), mild- (CONUT score = 1–2), moderate- (CONUT score = 3–4), or high- (CONUT score ≥5) risk groups, according to the previously published criteria (Mizobuchi K, Nutrients. 2019;11(8):1745). The moderate- and high-risk groups were combined to form a moderate-to-high risk group before statistical analysis. PNI was calculated using the following formula: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte counts of peripheral blood (/μL), and the patients were allocated to groups as tertiles of PNI (T1–T3). Cox proportional hazard models were used to evaluate the associations between these indices and all-cause mortality. Harrell’s concordance C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to assess the predictive values of the CONUT score and PNI, when added to the basic risk model, which was composed of traditional CV risk factors.

During a median follow-up of 4.2 years, mortality from any cause occurred in 241 patients. In multivariable-adjusted Cox analyses, hazard ratios (HRs) (95% confidence intervals [CIs]) for all-cause mortality of the mild and moderate-to-high CONUT score groups were 1.38 (0.94–2.03) and 1.98 (1.29–3.05), respectively, compared with the low CONUT score group. In addition, the HRs (95% CIs) for all-cause mortality of T1 and T2 for PNI were 1.94 (1.29–2.92) and 0.95 (0.61–1.48), respectively, compared with T3. The C-statistic, NRI, and IDI significantly increased when the CONUT score and PNI were added to the basic risk model.

In patients with CKD, higher CONUT score and lower PNI were associated with all-cause mortality, and the addition of these indices to the basic risk factors increased the predictive value for all-cause mortality.

Kewords