Geriatric Nutritional Risk Index as a Screening Tool for Malnutrition in Patients on Chronic Peritoneal Dialysis Cheuk-Chun Szeto, MD, FRCP (Edin), Bonnie Ching-Ha Kwan, MBBS, MRCP (UK), Kai-Ming Chow, MBChB, MRCP (UK), Man-Ching Law, BN, RN, and Philip Kam-Tao Li, MD, FRCP Background: Malnutrition is common among peritoneal dialysis (PD) patients. Recently, the Geriatric Nutrition Risk Index (GNRI) was found to be a reliable tool for screening malnutrition in hemodialysis patients. However, the GNRI has not been validated in PD patients. Methods: We studied 314 unselected, adult PD patients from a single dialysis unit. We compared their GNRI scores with their comprehensive Malnutrition-Inflammation Scores (MIS) and 7-point Subjective Global Assessment (SGA) scores. We randomly selected 106 patients for a repeated assessment, and the changes in their three indices were compared. Results: Baseline GNRI was significantly correlated with MIS (r 520.487, P , .0001) and SGA (r 5 0.234, P , .0001). When MIS $6 was defined as malnutrition, the sensitivity and specificity of GNRI #93 in predicting malnutrition were 68.0% and 67.7%, respectively. When SGA #5 was used to define malnutrition, the sensitivity and specificity were 54.5% and 71.1%, respectively. The change in GNRI was correlated with the change in MIS (r 520.244, P 5 .012) and overall SGA score (r 5 0.266, P 5 .006), respectively. When an increase in MIS was defined as a worsening of nutrition, the sensitivity and specificity of GNRI were 45.7% and 81.7%, respectively. When a decrease in SGA was used to define a worsening of nutrition, the sensitivity and specificity were 42.3% and 87.0%, respectively. Conclusions: Although GNRI is significantly correlated with other nutritional indices, it is not sensitive for screen- ing malnutrition in PD patients. Serial measurements of GNRI are also not sensitive in detecting a change in nutritional status. Further study is needed to identify a simple and reliable tool for the assessment and monitoring of nutritional status in PD patients. Ó 2010 by the National Kidney Foundation, Inc. All rights reserved. M ALNUTRITION IS A common and seri- ous problem in patients with endstage re- nal disease treated with peritoneal dialysis (PD). 1–3 Malnutrition in PD patients may be caused by a variety of factors, including anorexia, predialysis dietary restriction, altered protein me- tabolism, dialysis-related nutrient losses, acidosis, and inflammation. 4,5 More importantly, malnour- ished patients have significantly increased mortality and morbidity, compared with their well-nourished counterparts. 6 Because the development of malnu- trition is a gradual process, a simple and reliable method of assessment that could be conducted fre- quently is required for monitoring PD patients. However, an optimal technique for the nutritional assessment of PD patient remains to be established. The Malnutrition Inflammation Score (MIS) was recently developed. 7 The MIS system incorpo- rates the seven components of the Subjective Global Assessment (SGA), together with body mass index, serum albumin level, and total iron-binding capac- ity (TIBC), in an attempt to achieve a comprehen- sive assessment of nutritional status. The MIS was shown to have significant associations with prospec- tive hospitalization and mortality in patients on maintenance hemodialysis, and it was superior to its individual components as well as conventional SGA for predicting mortality. 7 Our previous study also showed that MIS has a reasonable correlation with conventional SGA scores in PD patients. 8 Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong, China. Address reprint requests to Cheuk-Chun Szeto, MD, FRCP (Edin), Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong, China. E-mail: ccszeto@cuhk.edu.hk Ó 2010 by the National Kidney Foundation, Inc. All rights reserved. 1051-2276/10/2001-0005$36.00/0 doi:10.1053/j.jrn.2009.04.004 Journal of Renal Nutrition, Vol 20, No 1 (January), 2010: pp 29–37 29