Determinants of nutritional risk assessed by the geriatric nutritional risk index in Vietnamese maintenance hemodialysis patients: A cross-sectional study

Abstract

Malnutrition is prevalent and strongly predicts adverse outcomes in maintenance hemodialysis (MHD) patients. The Geriatric Nutritional Risk Index (GNRI) is a validated nutritional risk screening tool for this population. This study determined the prevalence of nutritional risk and identified independent factors associated with GNRI scores in Vietnamese MHD patients.

Methods. A cross-sectional study enrolled 125 end-stage kidney disease (ESKD) patients on MHD for ≥ 3 months at the Dialysis Unit of the Rehabilitation and Occupational Disease Hospital, Ho Chi Minh City, Vietnam, from January to June 2025. Nutritional risk was assessed using the GNRI, calculated from serum albumin, actual body weight, and ideal body weight, and classified into four categories (no risk: GNRI > 98; low risk: 92–98; moderate risk: 82–<92; major risk: < 82). For binary prevalence reporting, patients were dichotomised as at any nutritional risk (GNRI ≤ 98) versus no risk (GNRI > 98), consistent with the original Bouillanne classification. Univariate analysis used Spearman’s correlation and the Mann–Whitney U test. Multivariable linear regression with backward elimination identified independent factors associated with GNRI scores.

Results. The mean GNRI score was 94.74 ± 6.75. Overall, 77 patients (61.6%) had any nutritional risk (GNRI ≤ 98), including 38 (30.4%) with low risk, 32 (25.6%) with moderate risk, and 7 (5.6%) with major risk. Multivariable regression identified five independent associated factors of lower GNRI scores: advanced age (B = −0.142; 95% CI: −0.216, −0.069; p < 0.001), diabetes mellitus (B = −2.229; 95% CI: −4.714, −0.085; p = 0.042), active hepatitis C virus (HCV) infection (B = −3.055; 95% CI: −5.847, −0.263; p = 0.032), higher epoetin alfa dose (B = −0.020; 95% CI: −0.033, −0.006; p = 0.005), and elevated parathyroid hormone (PTH) levels (B = −0.002; 95% CI: −0.003, −0.0001; p = 0.027). The final model explained 32.4% of the variance (adjusted R² = 0.324).

Conclusions. Nutritional risk is prevalent in Vietnamese MHD patients, affecting 61.6% of the cohort. Malnutrition severity is independently associated with advanced age, diabetes mellitus, active HCV infection, ESA hyporesponsiveness, and secondary hyperparathyroidism. Targeted interventions, including HCV treatment, optimisation of anaemia management, and mineral-bone disorder control, are essential to improve nutritional outcomes in this population.