The Impact of a Major Earthquake on Nutritional Status and Survival in Hemodialysis Patients: A Retrospective Observational Study.

OBJECTIVES

Malnutrition increases the risk of mortality in hemodialysis (HD) patients. The Geriatric Nutritional Risk Index (GNRI) is a robust tool that predicts mortality in HD patients, with changes in GNRI linked to survival. Our objective was to evaluate the impact of the 2011 Van earthquake on the nutritional status and short- and long-term survival of HD patients.

METHODS

This study was conducted in 2011-2012 across five dialysis centers in Van, Turkey. Patients aged ≥18 years, undergoing HD thrice weekly, and residing in the earthquake area for at least 1 year before and after the earthquake were included. Nutritional data were collected 1 month before the earthquake and at 1-, 6-, and 12-month postearthquake. The long-term impact of GNRI on survival was assessed, with a data cutoff date of December 2024, allowing for a follow-up period of up to 13 years postearthquakefor survival outcomes.

RESULTS

Nutritional parameters, including systolic/diastolic blood pressure, body mass index, hemoglobin, serum phosphate, serum triglycerides, postdialysis weight, and GNRI, showed changes after the earthquake, primarily a decrease. The largest changes were observed in systolic/diastolic blood pressures and serum phosphate (effect sizes: -0.47, -0.43, and -0.38, respectively). Patients with GNRI <90 increased from 13.4% pre-earthquake to 17.9% at 1 month but decreased to 11.7% by 6 months, indicating a transient impact. Importantly, a pre-earthquake GNRI <90 was associated with a worse prognosis (hazard ratio: 1.71, 95% CI confidence interval: 1.06-2.76, P = .03) in univariate analysis. In multivariate analyses, over 13 years, GNRI <90 was associated with a 78% higher mortality risk (hazard ratio: 1.78, 95% confidence interval: 1.33-2.90, P = .02), indicating its significance as a long-term predictor.

CONCLUSIONS

The impact of a major earthquake on short-term nutritional parameters was minimal and transient, with no observed direct impact on short-term survival. Long-term malnutrition, as assessed by the GNRI, is a significant predictor of long-term mortality, and its predictive capacity remained unaffected by the earthquake.