GLIM-Defined Nutritional Severity as a Potential Predictor of Acute Kidney Injury in Hospitalized Patients

 

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https://storage.unitedwebnetwork.com/files/1099/53a3cb088b4a4a6344b100f52ae11139.pdf
GLIM-Defined Nutritional Severity as a Potential Predictor of Acute Kidney Injury in Hospitalized Patients

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Naoko
Tsuji
Naoko Tsuji ntsuji@hama-med.ac.jp Hamamatsu University School of Medicine Internal Medicine 1 Hamamatsu Japan *
Ema Chiemi em@hama-med.ac.jp Hamamatsu University School of Medicine Internal Medicine 1 Hamamatsu Japan -
Taro Aoki aoki88@hama-med.ac.jp Hamamatsu University School of Medicine Internal Medicine 1 Hamamatsu Japan -
Naoko Katahashi kths@hama-med.ac.jp Hamamatsu University School of Medicine Internal Medicine 1 Hamamatsu Japan -
Sayaka Ishigaki ishigaki@hama-med.ac.jp Hamamatsu University Hospital Blood Purification Unit Hamamatsu Japan -
Takamasa Iwakura tkms0421@hama-med.ac.jp Hamamatsu University School of Medicine Internal Medicine 1 Hamamatsu Japan -
Shinsuke Isobe isobe58@hama-med.ac.jp Hamamatsu University Hospital Blood Purification Unit Hamamatsu Japan -
Tomoyuki Fujikura tfuji@hama-med.ac.jp Hamamatsu University School of Medicine Internal Medicine 1 Hamamatsu Japan -
Naro Ohashi ohashi-n@hama-med.ac.jp Hamamatsu University School of Medicine Internal Medicine 1 Hamamatsu Japan -
Hideo Yasuda ysdh@hama-med.ac.jp Hamamatsu University School of Medicine Internal Medicine 1 Hamamatsu Japan -
 
 
 
 
 

Malnutrition is a well-established risk factor for adverse outcomes in hospitalized patients and may also be associated with acute kidney injury (AKI). However, the impact of malnutrition severity based on the internationally standardized Global Leadership Initiative on Malnutrition (GLIM) criteria on in-hospital AKI development has not been fully investigated. This study aimed to evaluate whether GLIM-defined malnutrition severity predicts the incidence of AKI during hospitalization.

We conducted a retrospective observational study of 114 inpatients referred to the Nutrition Support Team between March 2022 and December 2024 who were considered at high risk for AKI due to chemotherapy, infectious diseases, or heart failure. Nutritional status was classified according to the GLIM criteria as no malnutrition, moderate, or severe malnutrition. The primary outcome was new-onset AKI after nutritional assessment. Secondary variables included age, sex, eGFR, and underlying disease. Secondary outcomes were length of hospital stay, ICU admission, and unfavorable outcomes. Statistical analyses were performed using chi-square tests and multivariable logistic regression.

AKI developed in 46 patients (40%). The incidence of AKI increased significantly according to GLIM severity: 23% in no malnutrition, 47% in moderate malnutrition, and 60% in severe malnutrition (p = 0.0039). In multivariable analysis, the GLIM score remained independently associated with AKI (odds ratio 2.22, 95% CI 1.26–3.92, p = 0.006), indicating that each increase in GLIM category approximately doubled the risk. Length of hospital stay tended to be longer with greater malnutrition severity (53.5, 62, and 72 days). AKI cases had higher rates of ICU admission (28.3% vs. 5.9%) and unfavorable outcomes (41.3% vs. 14.9%) than non-AKI cases.

GLIM-defined malnutrition severity at the time of NST intervention was independently associated with an increased risk of in-hospital AKI, as well as higher rates of ICU admission and unfavorable outcomes. Nutritional severity assessment using the GLIM criteria may serve as a valuable tool for early risk stratification and renal prognostication in hospitalized patients.

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