Body Composition in Dialysis Patients: A Functional Assessment of Bioimpedance Using Different Prediction Models

Broers, Natascha J. H.; Martens, Remy J H; Cornelis, T.; Diederen, Nanda M. P.; Wabel, Peter; Sande, Frank M. van der; Leunissen, Karel M.L.; Kooman, Jeroen P.

doi:10.1053/j.jrn.2014.08.007

Cited by 30 publications

(29 citation statements)

References 30 publications

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“…Patients were in the supine position. In HD patients, measurements were collected before dialysis, in agreement with previous studies [18][19][20] . In PD patients, measurements were taken during a visit at the out-patient clinic.…”

Section: Pa Measurementsmentioning

confidence: 87%

Physical Activity in End-Stage Renal Disease Patients: The Effects of Starting Dialysis in the First 6 Months after the Transition Period

Broers

Martens

Cornelis

et al. 2017

Nephron

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Objectives: Physical inactivity in end-stage renal disease (ESRD) patients is associated with increased mortality, and might be related to abnormalities in body composition (BC) and physical performance. It is uncertain to what extent starting dialysis influences the effects of ESRD on physical activity (PA). This study aimed to compare PA and physical performance between stage 5 chronic kidney disease (CKD-5) non-dialysis and dialysis patients, and healthy controls, to assess alterations in PA during the transition from CKD-5 non-dialysis to dialysis, and to relate PA to BC. Methods: For the cross-sectional analyses 44 CKD-5 non-dialysis patients, 29 dialysis patients, and 20 healthy controls were included. PA was measured by the SenseWear™ pro3. Also, the walking speed and handgrip strength (HGS) were measured. BC was measured by the Body Composition Monitor©. Longitudinally, these parameters were assessed in 42 CKD-5 non-dialysis patients (who were also part of the cross-sectional analysis), before the start of dialysis and 6 months thereafter. Results: PA was significantly lower in CKD-5 non-dialysis patients as compared to that in healthy controls but not as compared to that in dialysis patients. HGS was significantly lower in dialysis patients as compared to that in healthy controls. Walking speed was significantly lower in CKD-5 non-dialysis patients as compared to that in healthy controls but not as compared to that in dialysis patients. Six months after starting dialysis, activity related energy expenditure (AEE) and walking speed significantly increased. Conclusions: PA is already lower in CKD-5 non-dialysis patients as compared to that in healthy controls and does not differ from that of dialysis patients. However, the transition phase from CKD-5 non-dialysis to dialysis is associated only with a modest improvement in AEE.

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Section: Pa Measurementsmentioning

confidence: 87%

Physical Activity in End-Stage Renal Disease Patients: The Effects of Starting Dialysis in the First 6 Months after the Transition Period

Broers

Martens

Cornelis

et al. 2017

Nephron

Self Cite

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“…As mentioned before, serum albumin and nPCR continue to be valid parameters for the assessment of PEW in HD patients . We chose to add BCMI to this tool, as it represents body composition, one of the parameters recommended to assess PEW and, due to its susceptibility to harmful circumstances, such as inadequate nutrients intake or inflammation, it has been considered an adequate nutritional status marker by several authors …”

Section: Discussionmentioning

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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“…Using this method, FO was conventionally expressed by the ECW:ICW ratio or by normalized ECW [14]. Recently, a 3-compartment model was developed, differentiating between fat tissue mass (FTM), lean tissue mass (LTM) and an overhydration (OH) compartment, which is calculated based on assumptions regarding the hydration of lean- and adipose tissue [15, 16], Figure1. Different cutoff levels for this compartment have been used in the literature, varying between an OH:ECW ratio of 7–15% and absolute values of OH >+1.1 or >+2.5 L [2, 10, 14, 17].…”

Section: Assessment Of Fomentioning

confidence: 99%

Fluid Overload and Inflammation Axis

et al. 2018

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Extracellular fluid overload (FO), which is assessed using bioimpedance technologies, is an important predictor of outcome in dialysis patients and in patients with early stages of chronic kidney disease. While traditional cardiovascular abnormalities are assumed to mediate this risk, recently also, the importance of noncardiovascular factors, such as systemic inflammation and malnutrition has been shown. While both FO and inflammation are independent risk factors for mortality, recent studies have shown that their combined presence can lead to a cumulative risk profile. From a pathophysiologic viewpoint, FO and inflammation can also be mutually reinforcing. Inflammation could contribute to FO by hypoalbuminemia, capillary leakage, and a (unnoticed) decline in lean and/or fat tissue mass resulting in incorrect estimation of dry weight. Reciprocally, FO could lead to inflammation by the translocation of endotoxins through a congested bowel wall or by a proinflammatory effect of tissue sodium. The relative importance of these putative factors is, however, not clear yet and epidemiological studies have shown no clear temporal direction regarding the relationship between FO and inflammation. FO and inflammation appear to be part of (dynamic) clusters of risk factors, including malnutrition and hyponatremia. Technology-guided fluid management of the often vulnerable dialysis patient with FO and inflammation cannot yet be based on evidence from randomized controlled trials, in which these specific patients were in general not included. In the absence of those trials, treatment should be based on identifying actionable causes of inflammation and on the judicious removal of excess volume based on frequent clinical reassessment.

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Body Composition in Dialysis Patients: A Functional Assessment of Bioimpedance Using Different Prediction Models

Cited by 30 publications

References 30 publications

Physical Activity in End-Stage Renal Disease Patients: The Effects of Starting Dialysis in the First 6 Months after the Transition Period

Physical Activity in End-Stage Renal Disease Patients: The Effects of Starting Dialysis in the First 6 Months after the Transition Period

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

Fluid Overload and Inflammation Axis

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