Prognostic impact of severe malnutrition in dialysis patients who underwent transcatheter aortic valve replacement

Patients with aortic stenosis who are undergoing dialysis are typically considered to be at very high surgical risk. Malnutrition is reported to be significantly associated with all-cause mortality and cardiovascular events in patients undergoing transcatheter aortic valve replacement (TAVR). Although patients with end-stage renal disease undergoing dialysis have poorer outcomes after TAVR, the prognostic effect of nutritional status in this high-risk population remains unclear. Thus, we aimed to investigate the prognostic impact of nutritional status in dialysis patients who underwent TAVR. This retrospective observational study included 106 dialysis patients who underwent TAVR at Tokyo Women's Medical University. Patients were categorized into four groups according to their Geriatric Nutritional Risk Index (GNRI) values: <82, 82-<92, 92-98, and >98, reflecting severe, moderate, mild, and no nutritional risks, respectively. The primary outcome measure was the all-cause mortality. During a median follow-up of 367 days, all-cause mortality was observed in 35.9% of the overall cohort. Risk stratification according to GNRI was significantly associated with prognosis (log-rank p < 0.001). Notably, patients with severe malnutrition (GNRI <82) had higher mortality than those in other GNRI categories. Nutritional stratification based on GNRI is a useful prognostic indicator. GNRI may provide complementary prognostic information for risk assessment in this high-risk population.