Association between Geriatric Nutrition Risk Index, Bone Marrow Density, Body Composition and Handgrip Strength in Patients Receiving Hemodialysis

Introduction: Malnutrition occurs as a complication of hemodialysis (HD) and has been identified as a risk factor for osteoporosis, sarcopenia and low physical performance. In this study, we assess the association between nutrition, bone marrow density (BMD), body composition and handgrip strength in HD patients.

Methods: We enrolled 164 patients with HD who have received the dual energy X-ray absorptiometry (DXA) examination, categorized according to baseline geriatric nutritional risk index (GNRI) values calculated by serum albumin levels and body weight index. Besides, handgrip strength test was performed.

Results: Compared with those patients with tertile 1 of GNRI, patients with tertile 3 of GNRI tend to have higher lumbar spine BMD and T-score, higher femoral neck BMD, higher total hip BMD, higher left distal 1/3 radius BMD and T-score, higher fat mass index, higher android/gynoid ratio, higher lean mass index and higher handgrip strength. An increase in GNRI tertile was associated with an increase of normal BMD and a decrease of osteoporosis prevalence. Low lean mass index and high parathyroid hormone were significantly associated with low BMD and T-score. In addition, high GNRI and high left distal 1/3 radius BMD were significantly associated with high handgrip strength.

Conclusions: Our study demonstrated that good nutrition, indicated as high GNRI, had higher BMD and T-score, higher lean mass index and higher handgrip strength in HD patients. Using GNRI to evaluate nutritional status, and using DXA to investigate BMD and body composition in patients with HD is important to bone health and physical performance.