Fat-to-Lean Mass Ratio Can Predict Cardiac Events and All-Cause Mortality in Patients Undergoing Hemodialysis

Abstract

Background: Although higher body mass index (BMI) is associated with better survival in patients undergoing dialysis, BMI is not an adequate obesity indicator. We hypothesized that the fat-to-lean (F/L) mass ratio could be a suitable marker of nutritional status and evaluated its prognostic impact on long-term outcomes in patients undergoing hemodialysis (HD). Methods: In total, 131 patients undergoing HD were recruited and monitored prospectively for up to 5 years. Body composition was analyzed, and other nutritional and inflammatory parameters were measured. Results: The mean age of the cohort was 60.7 ± 13.6 years, and 65 patients were diabetic. Age, sex, diabetes, comorbidity, and inflammation were associated significantly with the F/L mass ratio. During the follow-up period, 21 patients experienced cardiac events and 22 patients died. Patients with higher F/L mass ratios had significantly higher risks of all-cause death (hazard ratio [HR] 3.61, 95% CI 1.07–12.13; p = 0.038) and cardiac events (HR 3.54, 95% CI 1.05-11.94; p = 0.041) than those with lower F/L mass ratios. Conclusions: The F/L mass ratio was a useful surrogate marker of nutritional and inflammatory status, and an independent predictor of cardiac events and all-cause mortality, in patients undergoing HD.

Three compartment bioimpedance spectroscopy in the nutritional assessment and the outcome of patients with advanced or end stage kidney disease: What have we learned so far?

“…It has also been suggested that BIS could also play a role in the diagnosis of sarcopenic obesity in dialysis patients by investigating the relationship between ATM and LTM …”

“…Patients with normal LTI but FTI > 90th percentile also tended to have an increased mortality . Lee et al observed a relation between the fat tissue/lean tissue (FM/LTM) ratio, as a proposed surrogate of sarcopenic obesity, and the risk of cardiac events and all‐cause mortality in a cohort of 130 HD patients . It should be noted that the quartile with the highest FM/LTM ratio was characterized both by the highest FM as well as the lowest LTM, which makes the interpretation of the individual contribution of the respective body compartments somewhat difficult to interpret.…”

“…This relation may be caused by the underlying disease state, leading to wasting, but also because skeletal muscle is an important reservoir of proteins . Next to this, a low LTI contributes to muscle weakness and frailty with an increased risk of complications and may be associated with a reduced physical activity, which is at itself a risk factor for mortality . Moreover, also a low FTI may be a sign of serious underlying disorders, where severely depleted fat stores could interfere with the homeostatic response to a stressor such as infection or surgery, given the fact that fat is an important source of energy.…”

“…Whereas a low LTI was related to FO and inflammation, the study of Lee et al showed that in male subjects, the FM/LTM ratio was also positively related to hsCRP and interleukin‐6 . In PD patients, changes in FTI were also positively related to changes in inflammatory status .…”

Low body cell mass index in hemodialysis patients: Association with clinical parameters and survival

“…2,5 Despite the data showing a link between body cell mass index (BCMI) and nutritional status in HD patients, the clinical significance of muscle and fat mass HD patients' clinical outcomes and mortality has been more extensively studied than BCMI. 2,4,[6][7][8] In addition to body composition parameters, the monitoring of several laboratory parameters is also routine practice for nutritional status assessment in these patients and a decrease in albumin, phosphorus, or serum creatinine levels represents negative outcomes. 1,8 Thus, the aim of this study was to investigate the association of BCMI with nutritional parameters as well as its relationship with long-term survival in maintenance HD patients.…”