Lower thigh muscle mass is associated with all-cause and cardiovascular mortality in elderly hemodialysis patients

Fukasawa, Hirotaka; Kaneko, Mai; Niwa, Hiroki; Matsuyama, Takashi; Yasuda, Hideo; Kumagai, Hiromichi; Furuya, Ryuichi

doi:10.1038/ejcn.2016.186

Cited by 27 publications

(17 citation statements)

References 35 publications

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“…The finding was inconsistent with a previous study with more than 4 years of follow-up which showed that lower thigh muscle mass associated with higher mortality in hemodialysis patients. [33] Another study elucidated the association between lean body mass and survival among patients undergoing hemodialysis in different race and ethnicity. [34] Low lean body mass also showed a strong association with a higher rate of hospitalization and mortality in hemodialysis patients in a long-term follow-up study.…”

Section: Discussionmentioning

confidence: 99%

Mid-arm circumference, body fat, nutritional and inflammatory biomarkers, blood glucose, dialysis adequacy influence all-cause mortality in hemodialysis patients

Duong

Wong

et al. 2019

Medicine

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Hemodialysis patients are at the high risk for morbidity and mortality. Evaluation and management of body composition and biochemical values are important to improve dialysis outcomes. We aimed to examine the effects of the mid-arm circumference, body fat, nutritional and inflammatory biomarkers, blood glucose, and dialysis adequacy on the mortality. A prospective cohort study was conducted on 375 patients from 7 hospital-based dialysis centers. At baseline between September 2013 and April 2017, we assessed patients’ characteristics using chart review, body composition using the bioelectrical impedance analysis, and biochemical parameters using available laboratory tests. Patients were followed-up for all-cause mortality until April 2018. Kaplan–Meier Curves with Log-rank test, and Cox proportional hazards models were used to analyze the effects of assessed factors on the mortality. During the median of follow-up time of 1.4 (1.0–3.2) years, 47 (12.5%) patients died. In the multivariate analysis, mid-arm circumference (hazard ratio, HR, 0.90; 95% confidence interval, 95%CI, 0.82–0.99; P = .036), body fat mass (HR, 0.95; 95%CI, 0.91–1.00; P = .031), percent body fat (HR, 0.96; 95%CI, 0.92–0.99; P = .024), serum creatinine (HR, 0.81; 95%CI, 0.68–0.96; P = .015), and eKt/V (HR, 0.07; 95%CI, 0.01–0.33; P = .001) reduced the mortality risk. Inflammation (HR, 2.90; 95%CI, 1.59–5.27; P < .001), hyperglycemia (HR, 2.16; 95%CI, 1.06–4.40; P = .033), and low serum uric acid (HR, 2.22; 95%CI, 1.15–4.31; P = .018) increased the death risk. In hemodialysis patients, the higher values of the mid-arm circumference, body fat, serum creatinine, uric acid, and dialysis adequacy were associated with lower mortality, whereas, inflammation and hyperglycemia associated with higher mortality.

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Section: Discussionmentioning

confidence: 99%

Mid-arm circumference, body fat, nutritional and inflammatory biomarkers, blood glucose, dialysis adequacy influence all-cause mortality in hemodialysis patients

Duong

Wong

et al. 2019

Medicine

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“…Imaging techniques, such as computerized tomography (CT) and magnetic resonance imaging (MRI) or dual‐energy x‐ray absorptiometry (DEXA), have higher degree of precision and accuracy, and are also considered gold standards in the clinical setting; however, their clinical applicability is low . Recently, lower thigh muscle mass assessed by CT has been associated with all‐cause and cardiovascular mortality in elderly patients on hemodialysis . The limitations of these highly reliable imaging techniques relate to their cost, radiation exposure, limited availability at the bedside, the need for highly skilled operators and, in the case of DEXA, the influence of the hydration status.…”

Section: Protein Energy Wasting and Nutritional Status Evaluation In mentioning

confidence: 97%

“…5 Recently, lower thigh muscle mass assessed by CT has been associated with all-cause and cardiovascular mortality in elderly patients on hemodialysis. 22 The limitations of these highly reliable imaging techniques relate to their cost, radiation exposure, limited availability at the bedside, the need for highly skilled operators and, in the case of DEXA, the influence of the hydration status.…”

Section: Nutritional Status Evaluation In Esrdmentioning

confidence: 99%

Dietary protein and nutritional supplements in conventional hemodialysis

Sabatino

Piotti

Cosola

et al. 2018

Seminars in Dialysis

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Protein energy wasting (PEW) is a condition commonly occurring among patients with ESRD on hemodialysis. PEW is characterized by depletion of protein and energy stores and is caused by multiple factors related to chronic kidney disease, acute and chronic comorbidities and by renal replacement therapy itself. Anorexia is central in the pathogenesis of PEW; it is frequently observed in these patients whose protein and energy intakes are typically lower than guidelines recommendations. If untreated, PEW invariably leads to major complications, and may activate a vicious circle with further worsening of nutritional status. Dietary counseling and nutritional status monitoring play a key role in the prevention and treatment of PEW, since they allow an early identification of high risk patients, as well as the assessment of the response to nutritional intervention. Different nutritional approaches can be implemented following thorough nutritional counseling. These are chosen on the basis of patients' spontaneous dietary intake, severity of PEW and acute comorbidities. Initially, regular encounters with the dietitian allow patients to clarify doubts and strengthen basic concepts on nutrition to improve dietary intake and prevent PEW. When PEW is present or the patient is at high risk, the clinician may opt for the administration of oral intradialytic or daily supplements, aiming at increasing energy and protein intake, while in selected cases intradialytic parenteral nutrition may be used. This review addresses the main issues of nutritional status in ESRD patients on hemodialysis-its evaluation and monitoring, as well as at describing the available nutritional interventions.

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“…Often, they do not have clear signs of malnutrition/PEW according to the standard parameters, such as prealbumin or transferrin levels, and their albumin levels may be modulated more by type of dialysis than by other means. Yet, they have a severely reduced muscle mass, and this reduction is correlated with survival [81,[84][85][86][87]. However, it is not unusual to find that these thin, fragile patients have very high dialysis efficiency, often linked to their low BMI and volume distribution, whose dialysis prescription should probably be decreased rather than increased [29,30].…”

Section: From the "Skeleton Man" To The Obese Sarcopenic Patientmentioning

confidence: 99%

Section: From the "Skeleton Man" To The Obese Sarcopenic Patientmentioning

confidence: 99%

Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

et al. 2020

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Dialysis and nutrition are two sides of the same coin—dialysis depurates metabolic waste that is typically produced by food intake. Hence, dietetic restrictions are commonly imposed in order to limit potassium and phosphate and avoid fluid overload. Conversely, malnutrition is a major challenge and, albeit to differing degrees, all nutritional markers are associated with survival. Dialysis-related malnutrition has a multifactorial origin related to uremic syndrome and comorbidities but also to dialysis treatment. Both an insufficient dialysis dose and excessive removal are contributing factors. It is thus not surprising that dialysis alone, without proper nutritional management, often fails to be effective in combatting malnutrition. While composite indexes can be used to identify patients with poor prognosis, none is fully satisfactory, and the definitions of malnutrition and protein energy wasting are still controversial. Furthermore, most nutritional markers and interventions were assessed in hemodialysis patients, while hemodiafiltration and peritoneal dialysis have been less extensively studied. The significant loss of albumin in these two dialysis modalities makes it extremely difficult to interpret common markers and scores. Despite these problems, hemodialysis sessions represent a valuable opportunity to monitor nutritional status and prescribe nutritional interventions, and several approaches have been tried. In this concept paper, we review the current evidence on intradialytic nutrition and propose an algorithm for adapting nutritional interventions to individual patients.

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Lower thigh muscle mass is associated with all-cause and cardiovascular mortality in elderly hemodialysis patients

Abstract: Lower thigh muscle mass is significantly associated with all-cause and cardiovascular mortality in hemodialysis patients. Our findings indicate the importance of focusing on the muscle mass of lower extremities to predict the clinical outcomes of hemodialysis patients.

Cited by 27 publications

References 35 publications

Mid-arm circumference, body fat, nutritional and inflammatory biomarkers, blood glucose, dialysis adequacy influence all-cause mortality in hemodialysis patients

Mid-arm circumference, body fat, nutritional and inflammatory biomarkers, blood glucose, dialysis adequacy influence all-cause mortality in hemodialysis patients

Dietary protein and nutritional supplements in conventional hemodialysis

Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

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