Relationship between immune nutrition index and all-cause and cause-specific mortality in U.S. adults with chronic kidney disease

Junlin Zhang; Xiang Xiao; Tianzhao Han; Yuping Liu; Ping Shuai

doi:10.3389/fnut.2023.1264618

Relationship between immune nutrition index and all-cause and cause-specific mortality in U.S. adults with chronic kidney disease

Front Nutr. 2023 Dec 14:10:1264618. doi: 10.3389/fnut.2023.1264618. eCollection 2023.

Authors

Junlin Zhang^#^{1

2}, Xiang Xiao^#³, Tianzhao Han², Yuping Liu¹, Ping Shuai¹

Affiliations

¹ Department of Health Management and Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
² Department of Nephrology, The Third People's Hospital of Chengdu, Southwest Jiaotong University, Chengdu, China.
³ Department of Nephrology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China.

^# Contributed equally.

Abstract

Objective: The available evidence regarding the association of immune nutrition status with chronic kidney disease (CKD) is limited. Thus, the present study examined whether immunonutrition indices were associated with renal function and mortality among CKD individuals.

Research design and methods: This study enrolled 6,099 U.S. adults with CKD from the NHANES 2005-2018 database. Participants were matched with National Death Index records until 31 December 2019 to determine mortality outcomes. The time-dependent receiver operating characteristic was utilized to identify the most effective index among the prognostic nutritional index (PNI), system inflammation score (SIS), Naples prognostic score (NPS), and controlling nutritional status (CONUT) for predicting mortality. Cox regression models were employed to evaluate the associations of immunonutrition indices with mortality in participants with CKD.

Results: The PNI exhibited the strongest predictive power among the four indices evaluated and the restricted cubic spline analysis revealed a cutoff value of 51 for the PNI in predicting mortality. During a median follow-up of 72 months (39-115 months), a total of 1,762 (weighted 24.26%) CKD participants died from all causes. The Kaplan-Meier curve demonstrated a reduced risk of death for the subjects with a higher PNI compared to those in the lower group. Besides, after adjusting for multiple potential confounders, a higher PNI remained an independent predictor for lower risks of all-cause mortality (HR 0.80, 95%CI: 0.71-0.91, p < 0.001) and cardiovascular disease (CVD) mortality (HR 0.69, 95%CI: 0.55-0.88, p = 0.002) in individuals with CKD.

Conclusion: In CKD, a higher PNI level was significantly associated with lower mortality from all causes and CVD. Thus, the clinical utility of this immunonutrition indicator may facilitate risk stratification and prevent premature death among patients with CKD.

Keywords: all-cause mortality; cardiovascular disease; chronic kidney disease; immunonutrition; prognostic nutritional index.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was supported by the Sichuan Science and Technology Program of Sichuan Province (No. 2023NSFSC1529), the Science and Technology Foundation of Chengdu Medical College (No. CYZYB22-02), and the Key R&D Program of the Department of Science and Technology of Sichuan Province (2022YFS0600).