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

Q: What are the key findings of this study?

Severe malnutrition (GNRI <82) significantly increased 1-year all-cause mortality compared to GNRI ≥82 (HR 4.30) in dialysis patients undergoing transcatheter aortic valve replacement.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Severe aortic stenosis in patients undergoing dialysis (n=106). Intervention: Severe malnutrition (Geriatric Nutritional Risk Index [GNRI] <82) vs. GNRI ≥82 (moderate, mild, or no malnutrition). Primary outcome: All-cause mortality at 1 year (HR 4.30, 95% CI 2.05-9.01, p=<0.001).

Q: What does this research mean for the field?

Severe malnutrition defined by a Geriatric Nutritional Risk Index below 82 is independently associated with significantly higher one-year all-cause mortality in dialysis patients undergoing transcatheter aortic valve replacement. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To investigate the prognostic impact of nutritional status evaluated by the Geriatric Nutritional Risk Index in dialysis patients undergoing transcatheter aortic valve replacement.

Yuki Nakata; Hisao Otsuki; Eiji Shibahashi; Ken Ogura; Naoki Serikawa; Ryo Ikeda; Takanori Kawamoto; Masafumi Yoshikawa; Tomohito Kogure; Satoru Domoto; Hiroshi Niinami; Junichi Yamaguchi

doi:10.1007/s12928-026-01350-7

September 19, 2026Cardiovascular Intervention and TherapeuticsOpen Access

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

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Key result

Severe malnutrition linked to ~4.3-fold higher 1-year mortality after TAVR in dialysis patients.

HR 4.30
95% CI 2.05-9.01
P<0.001
n=106

Why the study?

The prognostic effect of nutritional status in dialysis patients undergoing TAVR remains unclear despite their high surgical risk and poorer outcomes.

Does severe malnutrition predict all-cause mortality in dialysis patients undergoing TAVR?

Key Points

To investigate the prognostic impact of nutritional status evaluated by the Geriatric Nutritional Risk Index in dialysis patients undergoing transcatheter aortic valve replacement.
Retrospective observational study of 106 dialysis patients who underwent transcatheter aortic valve replacement (TAVR) at Tokyo Women's Medical University.
Patients were classified into four groups using the Geriatric Nutritional Risk Index (GNRI): severe (<82; n=13), moderate (82–<92; n=31), mild (92–98; n=37), and normal nutritional status (>98; n=25).
The primary outcome was all-cause mortality tracked over a median follow-up of 367 days (interquartile range, 176–440 days).
All-cause mortality was observed in 35.9% of the overall cohort, occurring in 76.9% (10/13) of the GNRI <82 group, 35.5% (11/31) of the 82–<92 group, 27.0% (10/37) of the 92–98 group, and 28.0% (7/25) of the >98 group (log-rank p < 0.001).
Patients with severe malnutrition (GNRI <82) had a significantly higher risk of all-cause mortality compared with patients with GNRI ≥82 (HR: 4.30, 95% CI: 2.05–9.01; p < 0.001).
Analyzed as a continuous variable, every 1-point decrease in GNRI was significantly associated with 1-year all-cause mortality (HR: 1.08, 95% CI: 1.03–1.12; p < 0.001).

Study Design

Type

Observational (n=106)

Multicenter

No

Structured PICO

Does severe malnutrition predict all-cause mortality in dialysis patients undergoing TAVR?

P

Population

106 older adult dialysis patients (mean age 80.4 years, 41.5% female) with severe aortic stenosis undergoing transcatheter aortic valve replacement, followed for a median of 367 days.

E

Exposure

Severe malnutrition defined by a Geriatric Nutritional Risk Index (GNRI) <82.

C

Comparator

Moderate (GNRI 82-<92), mild (GNRI 92-98), or no nutritional risk (GNRI >98) (grouped as GNRI ≥82).

O

Outcome

All-cause mortality at 1 year after the procedure.hard clinical

Main Result

Hazard Ratio: 4.3 (95% CI 2.05–9.01)

p-value: p=<0.001

In dialysis patients undergoing TAVR, severe malnutrition assessed by GNRI is strongly associated with 1-year all-cause mortality, offering incremental prognostic value beyond conventional surgical risk scores.

Limitations

Single-center, retrospective observational design, which may lead to selection bias
Small sample size leading to potential model instability and overfitting
Residual confounding by measured and unmeasured factors such as systemic inflammation, volume status, heart-failure severity, and comorbidity burden
Lack of formal frailty or sarcopenia assessments (e.g., gait speed, Katz Index, skeletal muscle mass)
Conducted at a certified TAVR training center, potentially referring more complex cases compared with general hospitals

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Implication

Severe malnutrition flags high post-TAVR mortality in dialysis patients; hypothesis-generating and should not yet change practice.

Abstract

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.

Discussion

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Cite This Study

Nakata et al. (2026) conducted an observational in Severe aortic stenosis in patients undergoing dialysis (n=106). Severe malnutrition (Geriatric Nutritional Risk Index [GNRI] <82) vs. GNRI ≥82 (moderate, mild, or no malnutrition) was evaluated on All-cause mortality at 1 year (HR 4.30, 95% CI 2.05-9.01, p=<0.001). Severe malnutrition (GNRI <82) significantly increased 1-year all-cause mortality compared to GNRI ≥82 (HR 4.30) in dialysis patients undergoing transcatheter aortic valve replacement.

synapsesocial.com/papers/6ad0fd1915427f6a8404050c https://doi.org/10.1007/s12928-026-01350-7

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

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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