Investigation of the effects of prognostic nutritional index and dialysis afficiency parameters on cardiovascular results in chronic dialisis patients

INTRODUCTION: Chronic Kidney Disease (CKD) is a disease that is increasingly common in the world and in our country, has high morbidity and mortality, but has low awareness and early diagnosis rate, and negatively affects the quality of life. Although the life expectancy of patients with end-stage renal failure (ESRD) has increased as a result of the widespread use of hemodialysis, peritoneal dialysis and transplantation treatments today, the mortality rates of patients receiving dialysis treatment have increased 5-20 times compared to healthy individuals in the same age group. The most common cause of death in hemodialysis and peritoneal dialysis patients is cardiovascular diseases. The prognostic nutritional index, which is a combined indicator of inflammation and nutritional status, is based on serum albumin concentration and total peripheral lymphocyte count and can be easily calculated with these routinely evaluated parameters. Although the Prognostic Nutritional Index was initially used to determine the prognosis of cancer, recent studies suggest that it is also associated with the prognosis in cardiovascular disease, Covid-19, lymphomas, esophageal cancer, and chronic renal failure. MATERIALS-METHODS: 971 dialysis patients receiving hemodialysis and peritoneal dialysis treatments at Akdeniz University Hospital were included in the study. 902 patients were in the hemodialysis group and 69 patients were in the peritoneal dialysis group. Demographic characteristics of the patients, laboratory results, dialysis durations and previous RRT treatments, and calculated PNI values were examined and the patients' coronary artery disease and death status were recorded in the previously prepared data collection form. Prognostic Nutritional Index was calculated using the formula serum albumin (g/dl) + 5xtotal lymphocyte count (103/mL). The relationship between the obtained PNI value and the patients' coronary artery disease and mortality was evaluated. Information about the mortality status of the patients was obtained from the hospital automation system. RESULTS: A total of 971 patients, 902 hemodialysis and 69 peritoneal dialysis patients, were included in the study. 307(31.7%) patients had CAD and 206(21.2%) patients died. In the correlation analysis conducted with the hemodialysis patient group, it was found that the Prognostic Nutritional Index showed a negative correlation with CAD and mortality (p<0.01). At the same time, it was shown that there was a significant positive correlation between albumin, PTH and hemmoglobin and the Prognostic Nutritional Index (p<0.01). In the peritoneal dialysis patient group, a significant positive correlation was detected between Prognostic Nutritional Index and albumin. A negative correlation was detected between PTH and prognostic Nutritional Index. It was revealed that the prognostic Nutritional Index is an independent and inversely related parameter in predicting Coronary Artery Disease and mortality in hemodialysis patients. The optimum cut-off value of PNI for the cut-off value of the prognostic Nutritional Index for predicting coronary artery disease is ≤47.59. The sensitivity value was obtained as 56.20% and the specificity value as 56.20%. Area under the curve (AUC) 0.609; The 95% confidence interval was obtained as (0.570-0.647) (p<0.001). ). The optimum cut-off value of PNI to predict mortality is ≤46.17. The sensitivity value was obtained as 69.30% and the specificity value as 69.40%. Area under the curve (AUC) 0.767; The 95% confidence interval was obtained as (0.728-0.806) (p<0.001). CONCLUSION: The data we obtained as a result of our study shows that the Prognostic Nutritional Index is a new, independent and practical parameter that provides predictions about coronary artery disease and mortality in hemodialysis patients. In addition, further studies on how the PNI value can be used in clinical practice and continuous monitoring throughout the stages of CKD may provide more detailed information. Key Words; Prognostic Nutritional Index, Chronic Kidney Disease, Hemodialysis, Mortality, Coronary Artery Disease.