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

Vega, Almudena; Abad, Soraya; Macías, Nicolás; Aragoncillo, Inés; Santos, Alba; Galán, Isabel; Cedeño, Santiago; López‐Gómez, Juan M.

doi:10.1093/ckj/sfw126

Cited by 15 publications

(15 citation statements)

References 17 publications

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“…Also in patients with CKD stage 4–5, LTI appeared to be predictive for outcome. In a cohort of 356 patients, a lower LTI (defined as LTI < 14.1 kg/m 2 ) was associated with an increased mortality during a mean follow‐up time of 22 months . These results were confirmed in a study in 326 patients with CKD stages 3–5, in whom LTI above the median value, but not high BMI or FTI, was associated with improved outcomes.…”

Section: Relation Between Abnormalities In Body Composition and Outcomementioning

confidence: 78%

“…Although in our study, the association between low LTI and mortality was highly apparent in combination with FO and/or inflammation, the association lost significance when corrected for other risk domains . However, in the study of Vega et al, a low LTI added independent prognostic information for risk of mortality, whereas in the study of Castellano et al, a low LTI remained predictive for mortality after adjustment for FO, serum albumin, and the Charlson comorbidity index . In a study in 529 PD patients, LTI was not significantly associated with outcome in a model adjusted for FO, whereas in another study in 824 patients, this relation remained significant after adjustment for FO …”

Section: Association Of Abnormalities In Body Composition With Other mentioning

confidence: 82%

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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?

Broers

Canaud

Dekker

et al. 2020

Hemodialysis International

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Bioimpedance spectroscopy (BIS) is an easily applicable tool to assess body composition. The three compartment model BIS (3C BIS) conventionally expresses body composition as lean tissue index (LTI) (lean tissue mass [LTM]/height in meters squared) and fat tissue index (FTI) (adipose tissue mass/ height in meters squared), and a virtual compartment reflecting fluid overload (FO). It has been studied extensively in relation to diagnosis and treatment guidance of fluid status disorders in patients with advanced-stage or end-stage renal disease. It is the aim of this article to provide a narrative review on the relevance of 3C BIS in the nutritional assessment in this population. At a population level, LTI decreases after the start of hemodialysis, whereas FTI increases. LTI below the 10th percentile is a consistent predictor of outcome whereas a low FTI is predominantly associated with outcome when combined with a low LTI. Recent research also showed the connection between low LTI, inflammation, and FO, which are cumulatively associated with an increased mortality risk. However, studies toward nutritional interventions based on BIS data are still lacking in this population. In conclusion, 3C BIS, by disentangling the components of body mass index, has contributed to our understanding of the relevance of abnormalities in different body compartments in chronic kidney disease patients, and appears to be a valuable prognostic tool, at least at a population level. Studies assessing the effect of BIS guided nutritional intervention could further support its use in the daily clinical care for renal patients.

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Section: Relation Between Abnormalities In Body Composition and Outcomementioning

confidence: 78%

Section: Association Of Abnormalities In Body Composition With Other mentioning

confidence: 82%

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?

Broers

Canaud

Dekker

et al. 2020

Hemodialysis International

View full text Add to dashboard Cite

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“…Body composition may influence mortality in advanced CKD as we previously described [ 26 ]. Low LTI is associated with mortality.…”

Section: Discussionmentioning

confidence: 99%

Any grade of relative overhydration is associated with long-term mortality in patients with Stages 4 and 5 non-dialysis chronic kidney disease

Vega

Abad

Macías

et al. 2018

Clinical Kidney Journal

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BackgroundOverhydration (OH) is associated with mortality in chronic kidney disease (CKD). A relative overhydration adjusted for extracellular water (OH/ECW) measured by bioimpedance >15% has shown an increased mortality risk in haemodialysis but few studies have been developed in advanced CKD. Our objective was to evaluate the effect of OH on mortality in patients with Stage 4 or 5 non-dialysis CKD.MethodsWe performed a prospective study of 356 patients enrolled in 2011 and followed up until 2016. At baseline we collected general characteristics, serum inflammatory and nutrition markers, cardiovascular events (CVEs) and body composition using bioimpedance spectroscopy. During a median follow-up of 50 (24–66) months we collected mortality data.ResultsThe mean creatinine was 3.5 ± 1.3 mg/dL, median proteinuria was 0.5 [interquartile range (IQR) 0.2–1.5] g/24 h, median OH was 0.6 (IQR −0.4–1.5) L and mean relative OH (OH/ECW) was 2.3 ± 0.8%. We found that 32% of patients died. The univariate Cox analysis showed an association between mortality and age, diabetes, previous CVEs, Charlson comorbidity index, low albumin and pre-albumin, high C-reactive protein (CRP), low lean tissue and high OH/ECW. Multivariate Cox analysis confirmed an association between mortality and age {exp(B) 1.1 [95% confidence interval (CI) 1.0–1.3]; P = 0.001}, Charlson comorbidity index [exp(B) 1.1 (95% CI 1.0–1.2); P = 0.01], CRP [exp(B) 1.1 (95% CI 1.0–1.2); P = 0.04], OH/ECW [exp(B) 3.18 (95% CI 2.09–4.97); P = 0.031] and low lean tissue [exp(B) 0.82 (95% CI 0.69–0.98); P = 0.002]. Kaplan–Meier analysis confirmed higher mortality in patients with OH/ECW >0% (log rank 11.1; P = 0.001).ConclusionAny grade of relative OH measured by OH/ECW >0% is associated with long-term mortality in patients with Stage 4 or 5 non-dialysis CKD.

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“…Monitoring skeletal muscle composition and function may provide clinical value given the concerns of skeletal muscle wasting and neuromuscular dysfunction in CKD and its relationship with mortality [ 23 ]. Dual-energy X-ray absorptiometry (DXA), computed tomography (CT), magnetic resonance imaging (MRI) and bioelectrical impedance analysis (BIA) are frequently used to estimate skeletal muscle morphology and body composition in people with CKD within clinical research environments.…”

Section: Clinically Viable Approaches To Assessing Changes In Skeletamentioning

confidence: 99%

Chronic kidney disease: considerations for monitoring skeletal muscle health and prescribing resistance exercise

Gollie

Harris‐Love

Patel

et al. 2018

Clinical Kidney Journal

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Skeletal muscle wasting has gained interest as a primary consequence of chronic kidney disease (CKD) due to the relationship between skeletal muscle mass, mortality and major adverse cardiovascular events in this population. The combination of reductions in physical function, skeletal muscle performance and skeletal muscle mass places individuals with CKD at greater risk of sarcopenia. Therefore the monitoring of skeletal muscle composition and function may provide clinical insight into disease progression. Dual-energy X-ray absorptiometry and bioelectrical impedance analysis are frequently used to estimate body composition in people with CKD within clinical research environments, however, their translation into clinical practice has been limited. Proxy measures of skeletal muscle quality can be obtained using diagnostic ultrasound, providing a cost-effective and accessible imaging modality to aid further clinical research regarding changes in muscle composition. Clinicians and practitioners should evaluate the strengths and limitations of the available technology to determine which devices are most appropriate given their respective circumstances. Progressive resistance exercise has been shown to improve skeletal muscle hypertrophy of the lower extremities, muscular strength and health-related quality of life in end-stage renal disease, with limited evidence available in CKD predialysis. Fundamental principles (i.e. specificity, overload, variation, reversibility, individuality) can be used in the development of more advanced programs focused on improving specific neuromuscular and functional outcomes. Future research is needed to determine the applicability of skeletal muscle monitoring in clinical settings and the feasibility and efficacy of more advanced resistance exercise approaches in those with CKD predialysis.

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

Cited by 15 publications

References 17 publications

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?

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?

Any grade of relative overhydration is associated with long-term mortality in patients with Stages 4 and 5 non-dialysis chronic kidney disease

Chronic kidney disease: considerations for monitoring skeletal muscle health and prescribing resistance exercise

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