Association Between Body Mass Index and Body Fat in Chronic Kidney Disease Stages 3 to 5, Hemodialysis, and Peritoneal Dialysis Patients

Leinig, Cyntia Erthal; Pecoits‐Filho, Roberto; Nascimento, Marcelo Mazza do; Gonçalves, Simone; Riella, Miguel C.; Martins, Cristina

doi:10.1053/j.jrn.2008.04.001

Cited by 25 publications

(21 citation statements)

References 26 publications

(10 reference statements)

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“…A previous study indicated a stronger and more significant correlation between BMI and fat mass than between BMI and LBM in CKD patients at stages 3 to 5 (48). Hence, many previous studies assumed that the protective effect of BMI on mortality in MHD patients is related to fat mass and not LBM or muscle (20,48,49). We found a trend between higher peripheral fat mass, reflected by higher TSF and lower mortality, whereas we found a relatively consistent and graded association be- MICS variables include albumin, log erythropoietin dose, creatinine, hemoglobin, serum phosphorus, normalized protein catabolic rate (nPCR), bicarbonate, calcium, log ferritin, white blood count, lymphocyte percent, and body mass index.…”

Section: Discussionmentioning

confidence: 91%

“…Hence, muscle mass may possibly be more important than peripheral body fat mass in predicting survival, consistent with the hypothesis by Beddhu et al (11) that "if fat is good, muscle is better." A previous study indicated a stronger and more significant correlation between BMI and fat mass than between BMI and LBM in CKD patients at stages 3 to 5 (48). Hence, many previous studies assumed that the protective effect of BMI on mortality in MHD patients is related to fat mass and not LBM or muscle (20,48,49).…”

Section: Discussionmentioning

confidence: 99%

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Mid-Arm Muscle Circumference and Quality of Life and Survival in Maintenance Hemodialysis Patients

Noori¹,

Kopple²,

Kövesdy³

et al. 2010

Clinical Journal of the American Society of Nephrology

277

198

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Background and objectives: Maintenance hemodialysis (MHD) patients with larger body or fat mass have greater survival than normal to low mass. We hypothesized that mid-arm muscle circumference (MAMC), a conveniently measured surrogate of lean body mass (LBM), has stronger association with clinical outcomes than triceps skinfold (TSF), a surrogate of fat mass.Design, settings, participants, & measurements: The associations of TSF, MAMC, and serum creatinine, another LBM surrogate, with baseline short form 36 quality-of-life scores and 5-year survival were examined in 792 MHD patients. In a randomly selected subsample of 118 subjects, LBM was measured by dual-energy x-ray absorptiometry.Results: Dual-energy x-ray absorptiometry-assessed LBM correlated most strongly with MAMC and serum creatinine. Higher MAMC was associated with better short form 36 mental health scale and lower death hazard ratios (HRs) after adjustment for case-mix, malnutrition-inflammation-cachexia syndrome, and inflammatory markers. Adjusted death HRs were 1.00, 0.86, 0.69, and 0.63 for the first to fourth MAMC quartiles, respectively. Higher serum creatinine and TSF were also associated with lower death HRs, but these associations were mitigated after multivariate adjustments. Using median values of TSF and MAMC to dichotomize, combined high MAMC with either high or low TSF (compared with low MAMC/TSF) exhibited the greatest survival, i.e., death HRs of 0.52 and 0.59, respectively.Conclusions: Higher MAMC is a surrogate of larger LBM and an independent predictor of better mental health and greater survival in MHD patients. Sarcopenia-correcting interventions to improve clinical outcomes in this patient population warrant controlled trials.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Mid-Arm Muscle Circumference and Quality of Life and Survival in Maintenance Hemodialysis Patients

Noori¹,

Kopple²,

Kövesdy³

et al. 2010

Clinical Journal of the American Society of Nephrology

277

198

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“…Serum LDL-C and TG levels were also strongly correlated with serum IGF-I levels. BMI is considered to be strongly and significantly correlated with body fat mass in HD patients [41] but not with LBM. Data also indicate that circulating IGF-I levels, which are lower in HD patients compared with healthy controls, may be closely linked with the CVD risk in HD patients [42].…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Effects of Growth Hormone in Adult Hemodialysis Patients: Results from a Randomized Controlled Trial

et al. 2010

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Background/Aims: The high morbidity and mortality rates in hemodialysis (HD) patients are due, at least in part, to their increased risk for cardiovascular diseases (CVD). This prospective study evaluated the effect of growth hormone (GH) on a number of CVD risk markers in adult patients on HD. Methods: 139 HD patients were randomized to one of three GH doses or to placebo. Change from baseline in lean body mass (LBM), CVD risk markers (e.g. lipid profile, plasma homocysteine, inflammatory markers, blood pressure, IGF-I, IGFBP-3 and echocardiography) and correlations with serum IGF-I levels and body mass index were evaluated. Results: LBM increased in GH-treated groups compared with placebo (p < 0.001 pooled GH groups vs. placebo). IGF-I (p = 0.0027) and serum high-density-lipoprotein cholesterol levels (p = 0.038) increased with GH treatment. Serum low-density-lipoprotein cholesterol showed a trend to reduction. IGF-I was negatively correlated with plasma homocysteine levels (p = 0.01) and systolic blood pressure (p < 0.0001). Logistic regression analysis showed that interleukin-6, ghrelin and hematocrit values were significant determinants of all-cause mortality. Left ventricular mass was unchanged from baseline in GH-treated groups. Conclusion: In adult HD patients, GH treatment had a predominantly beneficial effect on CVD risk markers.

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“…To our knowledge, only a limited number of studies have examined the relative contributions of FM and LBM to clinical outcomes in CKD patients who undergo maintenance hemodialysis (MHD) (12,13). Some of these studies have suggested that the protective effect of high BMI against mortality is related to higher FM (14)(15)(16). Ramkumar et al (17), however, suggested that the protective effect of BMI in the MHD population is mostly conferred to those patients with a higher LBM, and hence muscle mass, as determined indirectly on the basis of urine creatinine content.…”

Section: Introductionmentioning

confidence: 99%

Survival predictability of lean and fat mass in men and women undergoing maintenance hemodialysis

Noori¹,

Kövesdy²,

Dukkipati³

et al. 2010

The American Journal of Clinical Nutrition

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Association Between Body Mass Index and Body Fat in Chronic Kidney Disease Stages 3 to 5, Hemodialysis, and Peritoneal Dialysis Patients

Cited by 25 publications

References 26 publications

Mid-Arm Muscle Circumference and Quality of Life and Survival in Maintenance Hemodialysis Patients

Mid-Arm Muscle Circumference and Quality of Life and Survival in Maintenance Hemodialysis Patients

Cardiovascular Effects of Growth Hormone in Adult Hemodialysis Patients: Results from a Randomized Controlled Trial

Survival predictability of lean and fat mass in men and women undergoing maintenance hemodialysis

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