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

Abstract

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.

Impact of Percent Body Fat on All-Cause Mortality among Adequate Dialysis Patients with and without Insulin Resistance: A Multi-Center Prospective Cohort Study

“…The most important finding of the current study is that a higher percent body fat was significantly associated with lower risk for all-cause mortality in the overall sample, and in patients with elevated HOMA-IR. In previous studies, body fat (as measured by percent body fat, or fat tissue, or body mass index) has been found to be an independent predictor for longer survival in hemodialysis patients [8,38,39,40,41,42]. In addition, a low baseline PBF and fat loss over time significantly increases mortality in maintenance hemodialysis patients, as found in a previous study [43].…”

The association of dialysis adequacy, body mass index, and mortality among hemodialysis patients

“…Despite constant efforts to improve the survival of hemodialysis (HD) patients, which have produced tangible results, their mortality rate remains high [1, 2]. Several factors affect survival in HD patients, with dialysis adequacy representing one of the most important and modifiable factors [3, 4]. Single-pool Kt/V urea (spKt/V), which is urea clearance multiplied by duration of treatment session and normalized for urea distribution volume, is universally employed as a measure of delivered dialysis dose.…”

Serum Uric Acid and Mortality in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis

“…The characteristics of the individual studies are listed in Table 1, and the selection of this study is elucidated in Figure 1. Six studies reported the relationship between SUA and mortality with peritoneal dialysis (PD) patients [13, 15, 19, 37, 38, 40], while 8 studies had hemodialysis (HD) cohorts [8, 17, 27, 30, 31, 34, 35, 39]. Seventeen studies collected the outcome of cardiovascular mortality.…”