{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:00:32Z","timestamp":1787029232406,"version":"build-2736575974"},"reference-count":26,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,8,19]],"date-time":"2021-08-19T00:00:00Z","timestamp":1629331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Although malnutrition and bone fracture are both major complications in patients undergoing hemodialysis, their association has not been clarified. The aim of our study was to clarify the association between the geriatric nutritional risk index (GNRI), an indicator of nutritional status, and the incidence of bone fractures in patients undergoing hemodialysis. Methods: We included 1342 registered patients undergoing hemodialysis and performed a post hoc analysis. We divided patients into the high GNRI group (\u226592), considered to have a low risk of malnutrition, and the low GNRI group (&lt;92), considered to have a high risk of malnutrition. Fracture-free survival in the low and high GNRI groups was evaluated by the Kaplan\u2013Meier method. Cox proportional hazards models were used to identify the risk factors for fractures requiring hospitalization. All results were stratified by sex. Results: New bone fractures developed in 108 (8.0%) patients in 5 years of follow-up. Bone fractures occurred more frequently in the low GNRI group compared with the high GNRI group (HR: 3.51, 95% CI: 1.91\u20136.42, p &lt; 0.01 in males; HR: 2.47, 95% CI: 1.52\u20134.03, p &lt; 0.01 in females). A low GNRI was significantly associated with an increased incidence of bone fractures, even after adjustment for covariates. However, the serum levels of calcium, phosphate, parathyroid hormone, and alkaline phosphatase were not associated with the incidence of bone fractures. Conclusions: A low GNRI is an independent risk factor for bone fractures in patients undergoing hemodialysis. Early intervention for the low GNRI group may be important in preventing the occurrence of fractures.<\/jats:p>","DOI":"10.3390\/nu13082847","type":"journal-article","created":{"date-parts":[[2021,8,19]],"date-time":"2021-08-19T09:58:06Z","timestamp":1629367086000},"page":"2847","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Lower Geriatric Nutritional Risk Index (GNRI) Is Associated with Higher Risk of Fractures in Patients Undergoing Hemodialysis"],"prefix":"10.3390","volume":"13","author":[{"given":"Maria","family":"Yoshida","sequence":"first","affiliation":[{"name":"Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7838-1494","authenticated-orcid":false,"given":"Ayumu","family":"Nakashima","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan"},{"name":"Department of Stem Cell Biology and Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigehiro","family":"Doi","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuya","family":"Maeda","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoki","family":"Ishiuchi","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayuki","family":"Naito","sequence":"additional","affiliation":[{"name":"Ichiyokai Yokogawa Clinic, 2-7-9 Yokogawacho, Nishi-ku, Hiroshima 733-0011, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takao","family":"Masaki","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1046\/j.1523-1755.2000.00178.x","article-title":"Increased risk of hip fracture among patients with end-stage renal disease","volume":"58","author":"Alem","year":"2000","journal-title":"Kidney Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1053\/j.ajkd.2005.09.024","article-title":"PTH and the Risks for Hip, Vertebral, and Pelvic Fractures Among Patients on Dialysis","volume":"47","author":"Danese","year":"2006","journal-title":"Am. J. Kidney Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1038\/ki.2013.279","article-title":"High rates of death and hospitalization follow bone fracture among hemodialysis patients","volume":"85","author":"Tentori","year":"2014","journal-title":"Kidney Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1146\/annurev.nutr.21.1.343","article-title":"Nutritional management of maintenance dialysis patients: Why Aren\u2019t We Doing Better?","volume":"21","author":"Mehrotra","year":"2001","journal-title":"Annu. Rev. Nutr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2238","DOI":"10.1046\/j.1523-1755.2002.00658.x","article-title":"Mortality risk in hemodialysis patients and changes in nutritional indicators: DOPPS","volume":"62","author":"Pifer","year":"2002","journal-title":"Kidney Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1093\/ajcn\/82.4.777","article-title":"Geriatric Nutritional Risk Index: A new index for evaluating at-risk elderly medical patients","volume":"82","author":"Bouillanne","year":"2005","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1093\/ajcn\/87.1.106","article-title":"Simplified nutritional screening tools for patients on maintenance hemodialysis","volume":"87","author":"Yamada","year":"2008","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.jjcc.2013.10.018","article-title":"Geriatric nutritional risk index accurately predicts cardiovascular mortality in incident hemodialysis patients","volume":"64","author":"Takahashi","year":"2014","journal-title":"J. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1007\/s40620-019-00676-1","article-title":"Geriatric nutrition risk index is associated with renal progression, cardiovascular events and all-cause mortality in chronic kidney disease","volume":"33","author":"Xiong","year":"2020","journal-title":"J. Nephrol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.bone.2014.04.017","article-title":"Epidemiology and mortality of hip fracture among patients on dialysis: Taiwan National Cohort Study","volume":"64","author":"Lin","year":"2014","journal-title":"Bone"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1111\/1744-9987.12807","article-title":"Hemodialysis Product and Hip Fracture in Hemodialysis Patients: A Nationwide Cohort Study in Japan","volume":"23","author":"Wakasugi","year":"2019","journal-title":"Ther. Apher. Dial."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1177\/0391398817752294","article-title":"N-terminal pro brain natriuretic peptide as a cardiac biomarker in Japanese hemodialysis patients","volume":"41","author":"Shimizu","year":"2018","journal-title":"Int. J. Artif. Organs"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1007\/s40620-013-0033-0","article-title":"Geriatric nutritional risk index is a strong predictor of mortality in hemodialysis patients: Data from the Riscavid cohort","volume":"27","author":"Panichi","year":"2014","journal-title":"J. Nephrol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1007\/s00198-004-1780-5","article-title":"Assessment of fracture risk","volume":"16","author":"Kanis","year":"2005","journal-title":"Osteoporos. Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1046\/j.1523-1755.1999.07304.x","article-title":"Pathogenesis of secondary hyperparathyroidism","volume":"56","author":"Slatopolsky","year":"1999","journal-title":"Kidney Int. Suppl."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1093\/ndt\/gfu055","article-title":"A higher serum alkaline phosphatase is associated with the incidence of hip fracture and mortality among patients receiving hemodialysis in Japan","volume":"29","author":"Maruyama","year":"2014","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.kisu.2017.04.001","article-title":"CKDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease\u2013Mineral and Bone Disorder (CKD-MBD)","volume":"7","author":"Wheeler","year":"2017","journal-title":"Kidney Int. Suppl."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1038\/sj.ki.5001754","article-title":"Incidence and risk factors for hip or other bone fractures among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study","volume":"70","author":"Jadoul","year":"2006","journal-title":"Kidney Int."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1053\/j.ajkd.2017.07.017","article-title":"Hip Fracture Trends in Japanese Dialysis Patients, 2008\u20132013","volume":"71","author":"Wakasugi","year":"2018","journal-title":"Am. J. Kidney Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1093\/ndt\/gfr317","article-title":"Diagnostic usefulness of bone mineral density and biochemical markers of bone turnover in predicting fracture in CKD stage 5D patients--a single-center cohort study","volume":"27","author":"Iimori","year":"2012","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1038\/sj.ki.5002585","article-title":"A proposed nomenclature and diagnostic criteria for protein\u2013energy wasting in acute and chronic kidney disease","volume":"73","author":"Fouque","year":"2008","journal-title":"Kidney Int."},{"key":"ref_22","first-page":"1048","article-title":"Geriatric nutritional risk index correlates with length of hospital stay and inflammatory markers in older inpatients","volume":"36","author":"Kraft","year":"2016","journal-title":"Clin. Nutr."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Lin, T.-Y., and Hung, S.-C. (2019). Geriatric Nutritional Risk Index Is Associated with Unique Health Conditions and Clinical Outcomes in Chronic Kidney Disease Patients. Nutrients, 11.","DOI":"10.3390\/nu11112769"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s00198-013-2524-1","article-title":"The clinical utility of FRAX to discriminate fracture status in men and women with chronic kidney disease","volume":"25","author":"Jamal","year":"2014","journal-title":"Osteoporos. Int."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1053\/j.ajkd.2017.01.052","article-title":"Modified Creatinine Index and the Risk of Bone Fracture in Patients Undergoing Hemodialysis: The Q-Cohort Study","volume":"70","author":"Yamada","year":"2017","journal-title":"Am. J. Kidney Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41598-020-62720-6","article-title":"Geriatric Nutritional Risk Index (GNRI) and Creatinine Index Equally Predict the Risk of Mortality in Hemodialysis Patients: J-DOPPS","volume":"10","author":"Yamada","year":"2020","journal-title":"Sci. Rep."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/8\/2847\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:47:07Z","timestamp":1760165227000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/8\/2847"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,19]]},"references-count":26,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["nu13082847"],"URL":"https:\/\/doi.org\/10.3390\/nu13082847","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,19]]}}}