Body Composition and Mortality Predictors in Hemodialysis Patients

Caetano, Cristina; Valente, Ana; Oliveira, Telma; Garagarza, Cristina

doi:10.1053/j.jrn.2015.10.005

Cited by 65 publications

(89 citation statements)

References 22 publications

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“…The association between body mass index (BMI) and mortality remains unclear in advanced CKD. The relationship between BMI and all-cause mortality has been confirmed in the general population, however this association has not always been displayed in CKD and results remains confusing [7, 8]. As body composition depends on both lean tissue and fat tissue mass, results may vary depending on the proportion of each relative to the other.…”

Section: Introductionmentioning

confidence: 99%

Low lean tissue mass is an independent risk factor for mortality in patients with stages 4 and 5 non-dialysis chronic kidney disease

Vega¹,

Abad²,

Macías³

et al. 2017

Clinical Kidney Journal

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Background: Mortality in patients with stages 4 and 5 chronic kidney disease (CKD) is higher than in the general population. Body composition predicts mortality. Our objective was to evaluate the effect of body composition on mortality in patients with stages 4 and 5 non-dialysis CKD. Methods: We performed a prospective study of 356 patients with stages 4 and 5 non-dialysis CKD. At baseline, we recorded general characteristics, history of cardiovascular events, body composition, serum inflammatory markers, nutrition and cardiac biomarkers. Body composition was analysed using bioimpedance spectroscopy. We recorded the lean tissue index (LTI), fat tissue index (FTI) and overhydration (OH). During a median (range) follow-up of 22 (3–49) months, we recorded mortality, cardiovascular events and progress to renal replacement therapy. Results: At baseline, mean (± standard deviation) age was 67 ± 13 years (men 64%; diabetes 36%). Mean body mass index was 28.2 ± 12.8 kg/m2, the FTI was 12.3 ± 5.6 kg/m2, the LTI was 15.7 ± 3.4 kg/m2 and median (interquartile range) OH was 0.6 (−0.4 to 1.5) L. Sixty-four (18%) patients died during follow-up. The univariate Cox analysis showed an association between mortality and age, low LTI, high Charlson comorbidity index, previous cardiovascular events, OH, low albumin and prealbumin levels, and high C-reactive protein levels. Kaplan–Meier analysis revealed higher survival in patients with a higher LTI (log-rank, 9.47; P = 0.002). The multivariate Cox analysis confirmed an association between mortality and low LTI (P = 0.031), previous cardiovascular events (P = 0.003) and high Charlson comorbidity index (P = 0.01). We did not find any association between body composition and cardiovascular events or renal replacement therapy. Conclusions: A low LTI is an independent factor for mortality in patients with stages 4 and 5 CKD.

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Section: Introductionmentioning

confidence: 99%

Low lean tissue mass is an independent risk factor for mortality in patients with stages 4 and 5 non-dialysis chronic kidney disease

Vega¹,

Abad²,

Macías³

et al. 2017

Clinical Kidney Journal

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“…The association of a lower BMI and higher mortality is well described in numerous studies . The ISRNM suggested it as a marker of body mass and includes the BMI <23 kg/m 2 in their criteria for the diagnosis of PEW …”

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confidence: 99%

Evaluating haemodialysis patient's nutritional status: Body mass index or body cell mass index?

Valente¹,

Caetano²,

Oliveira³

et al. 2019

Nephrology

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Objective Evaluate which of two combinations of parameters based on International Society of Renal Nutrition and Metabolism recommendations could better identify patients with protein‐energy wasting (PEW) and to compare the relationship of these two combinations with other clinical and body composition parameters. Methods This was a multicentre longitudinal study with 24 months of follow‐up. The PEW patients were characterized by: Group A (GA) – normalized protein catabolic rate (nPCR) < 1.0 g/kg per day, albumin <3.8 g/dL and body cell mass index (BCMI) < 6.4 kg/m2 (n = 203); Group B (GB) – nPCR <1.0 g/kg per day, albumin <3.8 g/dL and body mass index (BMI) <23 kg/m2 (n = 109). All the patients who did not meet these requirements were considered “well‐nourished” (GA: n = 1818; GB: n = 3292). Results When compared to the well‐nourished patients, PEW patients in the GA presented higher age, Kt/V, C‐reactive protein, relative overhydration, fat tissue index (FTI); lower creatinine, albumin, nPCR, PTH, haemoglobin, phosphorus, calcium X phosphorus product, potassium, dry weight, BMI, BCMI, lean tissue index, %IDWG . In the GB, well‐nourished patients FTI was significantly higher. In Cox analysis, the combination with BCMI was a strong independent predictor of mortality in these patients (hazard ratio: 1.48; confidence interval: 1.00–2.19; P = 0.048), even after adjustment. Although GB combination seemed to be also a predictor of death (hazard ratio: 2.67; confidence interval: 1.92–3.71; P < 0.001), when adjusted, the association remained no longer significant. Conclusion A new combination of parameters including protein intake, albumin and BCMI demonstrated significant associations with other nutrition and inflammation parameters as well as with mortality.

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“…18 In peritoneal dialysis patients, low serum Mg levels are associated with poorer nutritional status, deteriorating cellular health, increased inflammation, and lower BMI. 10,15 Another advantage of the body cell mass index is that this compartment excludes extracellular water, avoiding possible masking of the nutritional status. Body cell mass, which corresponds to fat-free mass without bone mineral mass and extracellular water, is the metabolically active compartment of the body.…”

Section: Discussionmentioning

confidence: 99%

“…7, 8 Recently, reports have indicated that overhydration, 9,10 low lean tissue index, 9,11 and low fat tissue index 10,11 measured using body composition monitors, were associated with high mortality in hemodialysis patients. 7, 8 Recently, reports have indicated that overhydration, 9,10 low lean tissue index, 9,11 and low fat tissue index 10,11 measured using body composition monitors, were associated with high mortality in hemodialysis patients.…”

Section: Introductionmentioning

confidence: 99%

Relationship of serum magnesium level with body composition and survival in hemodialysis patients

Mizuiri¹,

Nishizawa²,

Yamashita³

et al. 2019

Hemodialysis International

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Introduction: A relationship between serum magnesium (Mg) and body composition parameters has not been reported in hemodialysis (HD) patients. We aimed to clarify whether serum Mg has any association with body composition parameters, or survival in HD patients.Methods: This study included 215 consecutive maintenance HD patients. Laboratory data collection and postdialysis body composition analysis were performed at baseline. The patients were divided based on baseline serum Mg level tertiles (low, medium, and high Mg groups). Kaplan-Meier survival, logistic regression analyses and Cox proportional hazard analyses were conducted.Findings: Among all patients, the median age and dialysis vintage were 73 (65-81) years and 44 (8-96) months, respectively. The serum Mg levels were < 2.3, 2.3-2.5, and > 2.5 mg/dL for the low (n = 67), middle (n = 76), and high (n = 72) Mg groups, respectively. Compared to other groups, low Mg group showed significantly higher age and C-reactive protein levels, but lower serum albumin, normalized protein catabolic rates and frequency of on-line hemodiafiltration. The low, middle, and high Mg groups differed significantly regarding body cell mass (fat-free mass without bone mineral mass and extracellular water) index (BCMI): [5.6 (4.2-6.8), 6.0 (4.8-8.1), 6.7 (4.9-7.5) kg/m 2 , respectively] and overhydration/extracellular water ratio (OH/ECW) [11.7 (4.5-21.9), 4.8 (1.0-14.1), 8.5 (−0.5-15.0) %, respectively] but not regarding body mass index, lean tissue index, fat tissue index. Hypomagnesemia was significantly associated with BCMI [odds ratio (OR) [95% confidence interval (CI)]: 0.85 [0.73-1.00] and OH/ECW (OR [95% CI]: 1.03 [1.01-1.05]), respectively. Kaplan-Meyer 3-year survival rates were 53.6%, 69.7%, and 71.7% in low, middle, and high Mg groups, respectively. However, hypomagnesemia was not significantly associated with 3-year allcause mortality independent of age, serum albumin and C-reactive protein.Discussion: Hypomagnesemia was associated with lower BCMI, more pronounced OH/ECW and poorer Kaplan-Meier 3-year cumulative survival, but was not an independent risk factor for mortality in HD patients.

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Body Composition and Mortality Predictors in Hemodialysis Patients

Cited by 65 publications

References 22 publications

Low lean tissue mass is an independent risk factor for mortality in patients with stages 4 and 5 non-dialysis chronic kidney disease

Low lean tissue mass is an independent risk factor for mortality in patients with stages 4 and 5 non-dialysis chronic kidney disease

Evaluating haemodialysis patient's nutritional status: Body mass index or body cell mass index?

Relationship of serum magnesium level with body composition and survival in hemodialysis patients

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