Lean-to-fat tissue ratio as a risk factor for cognitive impairment in patients undergoing maintenance hemodialysis

Tian, Maolu; Yuan, Jing; He, Pinghong; Yu, Fangfang; Long, Chao; Zha, Yan

doi:10.1016/j.jpsychores.2023.111464

Cited by 3 publications

(4 citation statements)

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“…As described in our previous study, 8 patients' individual data such as comorbid conditions, sociodemographic characteristics, drug usage, blood pressure, dialysis mode, dialysis duration, and biochemistry parameters were collected from the dialysis run sheets, electronic medical record system and a face‐to‐face interview with a predesigned questionnaire. Patients with a high school level were defined as individuals who had received more than 9 years of schooling education.…”

Section: Methodsmentioning

confidence: 99%

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Low intracellular water and incident cognitive impairment in chronic hemodialysis patients

Tian,

Yuan,

et al. 2023

Int J Geriat Psychiatry

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ObjectiveTo explore the effect of intracellular water (ICW) evaluated by the bioelectrical Impedance Spectroscopy (BIS) on the risk of incident cognitive impairment (CI) in chronic hemodialysis (HD) patients.MethodsThree thousand three hundred eighty‐five patients were recruited and monitored prospectively for up to 3 years (the median follow‐up time, 2 years) in this observational cohort study. Mini‐Mental State Examination score (MMSE) was used to assess the global cognitive function. ICW was measured by body composition monitor based on BIS. Multiple Cox regression models, stratified analyses, and interactive analyses were conducted.ResultsDuring the follow‐up period, 1256 patients (37.1%) experienced incident CI. The incidence of CI was increased with decreasing quartiles of ICW (27.4%, 32.2%, 38.9%, and 50.1% for the fourth, third, second, and first quartiles, respectively). Decreased ICW was significantly associated with incident CI. The association remained statistically significant even after adjusting for age, sex, education, albumin, C‐reactive protein, residual renal function and various medical histories. The hazard ratios were 1.38 (1.17–1.64) and 1.28 (1.08–1.52) for ICW quartile 1 and quartile 2, respectively (reference, quartile 4). The association stably existed across subgroups, and the residual renal function had an interactive role in the association between ICW and incident CI (p = 0.014).ConclusionLow baseline ICW was an independent risk factor for CI in chronic HD patients. Our finding highlights the necessity of using BIS to measure body composition when assessing the risk of CI in HD patients.

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Section: Methodsmentioning

confidence: 99%

“…Some studies have sought to identify risk factors predisposing to CI, and body composition is one of these factors that have been paid attention 7–10 . Intracellular water (ICW) is a biomarker of cell hydration status and muscle mass.…”

Section: Introductionmentioning

confidence: 99%

Low intracellular water and incident cognitive impairment in chronic hemodialysis patients

Tian,

Yuan,

et al. 2023

Int J Geriat Psychiatry

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“…This study also included other variables such as sociodemographic and disease characteristics, lifestyle behaviors, and laboratory data. As described in our previous study, 33 these variables were acquired from a standardized questionnaire, dialysis run sheets, or electronic medical record system. More than 9 years of schooling education was classified as a high school level.…”

Section: Methodsmentioning

confidence: 99%

Decreased Intracellular to Total Body Water Ratio and Depressive Symptoms in Patients with Maintenance Hemodialysis

Tian,

Qian,

Long

et al. 2023

PRBM

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Objective Depression is a common psychiatric disorder and related to poor outcomes in patients undergoing maintenance hemodialysis (MHD). Previous studies have reported some associations between sarcopenia and depressive symptoms. Recently, intracellular water (ICW) and total body water (TBW) have been found to reflect muscle function and muscle mass. ICW/TBW ratio is a marker of sarcopenia that is simple to assess. However, the relationship between ICW/TBW ratio and depression has not been explored in MHD patients. Methods In our cross-sectional and multi-center study, 3300 adult MHD patients were included from June 1, 2021, to August 30, 2021. Depressive symptoms were evaluated using the Beck Depression Inventory-II (BDI-II). TBW and ICW were measured by Body Composition Monitor (BCM). Multivariable logistic regression, stratified analyses, and interactive analyses were conducted to assess the relationship between ICW/TBW ratio and depression. Results About 16.5% of the 3300 MHD patients were found to have depressive symptoms. The prevalence of depression increased with decreasing quartiles of ICW/TBW ratios, and decreased ICW/TBW ratio was independently associated with depression after adjusting for potential confounders. Patients in Quartile 1 of ICW/TBW ratios were more likely to have depressive symptoms (odds ratio 1.55, 95% confidence interval 1.07–2.22; p =0.002) than those in Quartile 4. History of diabetes and education status had interactive roles in the relationship between depression and ICW/TBW ratios ( p < 0.05). The association of ICW/TBW ratios and depression existed in patients of both genders and different education levels, but only in non-diabetic patients. Conclusion In MHD patients, the decreased ratio of ICW/TBW was independently related to high depression rates.

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“…Interestingly, Tian et al examined cognitive functions with the Mini-Mental State Examination Score (MMSE) among 3356 HD patients. Patients with a lower lean-to-fat tissue ratio (<1.27) based on BIS had a significantly higher risk of new onset cognitive impairment (defined as MMSE <27) (HR 1.51, 95% CI 1.24–1.81, p < 0.001) [ 80 ].…”

Section: Association Of Bioimpedance-derived Nutritional Parameters A...mentioning

confidence: 99%

Nutritional Assessments by Bioimpedance Technique in Dialysis Patients

Ng,

Lau,

Chan

et al. 2023

Nutrients

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Bioelectrical impedance analysis (BIA) has been extensively applied in nutritional assessments on the general population, and it is recommended in establishing the diagnosis of malnutrition and sarcopenia. The bioimpedance technique has become a promising modality through which to measure the whole-body composition in dialysis patients, where the presence of subclinical volume overload and sarcopenic obesity may be overlooked by assessing body weight alone. In the past two decades, bioimpedance devices have evolved from applying a single frequency to a range of frequencies (bioimpedance spectroscopy, BIS), in which the latter is incorporated with a three-compartment model that allows for the simultaneous measurement of the volume of overhydration, adipose tissue mass (ATM), and lean tissue mass (LTM). However, clinicians should be aware of common potential limitations, such as the adoption of population-specific prediction equations in some BIA devices. Inherent prediction error does exist in the bioimpedance technique, but the extent to which this error becomes clinically significant remains to be determined. Importantly, reduction in LTM has been associated with increased risk of frailty, hospitalization, and mortality in dialysis patients, whereas the prognostic value of ATM remains debatable. Further studies are needed to determine whether modifications of bioimpedance-derived body composition parameters through nutrition intervention can result in clinical benefits.

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Lean-to-fat tissue ratio as a risk factor for cognitive impairment in patients undergoing maintenance hemodialysis

Cited by 3 publications

References 53 publications

Low intracellular water and incident cognitive impairment in chronic hemodialysis patients

Low intracellular water and incident cognitive impairment in chronic hemodialysis patients

Decreased Intracellular to Total Body Water Ratio and Depressive Symptoms in Patients with Maintenance Hemodialysis

Nutritional Assessments by Bioimpedance Technique in Dialysis Patients

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