Nutritional Status of Maintenance Dialysis Patients: Low Lean Body Mass Index and Obesity Are Common, Protein-Energy Wasting Is Uncommon

Koefoed, Mette Marie; Kromann, Charles B; Juliussen, S.R.; Hvidtfeldt, D.; Ekelund, B; Frandsen, Niels Erik; Marckmann, Peter

doi:10.1371/journal.pone.0150012

Cited by 21 publications

(23 citation statements)

References 32 publications

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“…Low LTI and high FTI were found in 14.3% of male HD patients and 11.3% of females. These findings were in concordance with previous studies [9,[17][18][19], and confirm that low muscle mass can occur despite fat mass accumulation, a phenomenon called 'sarcopenic obesity'.…”

Section: Discussionsupporting

confidence: 92%

Evaluation of body composition monitoring for assessment of nutritional status in hemodialysis patients

et al. 2019

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Background: Body composition monitoring is the only clinically available method for distinguishing among the three body components. This study aimed to determine the relationship between body composition and all-cause mortality in Chinese hemodialysis patients and examine whether the lean tissue index (LTI) derived from body composition monitoring can accurately diagnose malnourished patients. Methods: Hemodialysis patients (n ¼ 123) with nutritional and body composition assessment records in 2015 were examined. Body composition was assessed using a body composition monitor machine. Results: Fifty-seven patients (46.3%) had low LTI (LTI less than the 10th percentile of the respective normal distribution). Significant differences in the fat tissue index (FTI) were observed, with the low LTI group having a higher FTI (10.8 kg/m 2 vs. 9.0 kg/m 2 , p¼ .007). The kappa coefficient of agreement between LTI and subjective global assessment (SGA) was 0.26 for the presence of malnutrition. During the mean observation period of 26.7 months, 20 of 123 (16.3%) patients died. Low LTI remained highly predictive of survival in the Cox regression analysis (hazard ratio: 3.24, 95% confidence interval 1.06-9.91, p¼ .04). Malnourishment defined by SGA predicted survival in the Kaplan-Meier analysis (log-rank v 2 ¼4.05; p¼ .04) but not in the multivariate analysis. Conclusions: LTI is a predictor of mortality, and its predictive power was not affected when FTI, SGA, and hydration status were included in the multivariate analysis. However, SGA may not be adequate to identify patients at a risk of death among Chinese hemodialysis patients.

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Section: Discussionsupporting

confidence: 92%

Evaluation of body composition monitoring for assessment of nutritional status in hemodialysis patients

et al. 2019

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“…Only 10% and 3% of our study participants were malnourished in the G A and G B , respectively. This prevalence is slightly lower than those verified in other studies using also the ISRNM methodology . Koefoed et al verified in their recent research that the nutritional status of the dialysis patients has improved in the last decades.…”

Section: Discussionmentioning

confidence: 79%

“…This prevalence is slightly lower than those verified in other studies using also the ISRNM methodology. [27][28][29] Koefoed et al verified in their recent research that the nutritional status of the dialysis patients has improved in the last decades. In the present study, the authors hypothesize that the increasing prevalence of obesity in the population along with the earlier onset of dialysis therapy and consequently the reduced frequency of severe predialytic malnutrition, as well as an improved focus on the nutritional status of these patients, contribute to this improvement.…”

Section: Discussionmentioning

confidence: 99%

Evaluating haemodialysis patient's nutritional status: Body mass index or body cell mass index?

Valente¹,

Caetano²,

Oliveira³

et al. 2019

Nephrology

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Objective Evaluate which of two combinations of parameters based on International Society of Renal Nutrition and Metabolism recommendations could better identify patients with protein‐energy wasting (PEW) and to compare the relationship of these two combinations with other clinical and body composition parameters. Methods This was a multicentre longitudinal study with 24 months of follow‐up. The PEW patients were characterized by: Group A (GA) – normalized protein catabolic rate (nPCR) < 1.0 g/kg per day, albumin <3.8 g/dL and body cell mass index (BCMI) < 6.4 kg/m2 (n = 203); Group B (GB) – nPCR <1.0 g/kg per day, albumin <3.8 g/dL and body mass index (BMI) <23 kg/m2 (n = 109). All the patients who did not meet these requirements were considered “well‐nourished” (GA: n = 1818; GB: n = 3292). Results When compared to the well‐nourished patients, PEW patients in the GA presented higher age, Kt/V, C‐reactive protein, relative overhydration, fat tissue index (FTI); lower creatinine, albumin, nPCR, PTH, haemoglobin, phosphorus, calcium X phosphorus product, potassium, dry weight, BMI, BCMI, lean tissue index, %IDWG . In the GB, well‐nourished patients FTI was significantly higher. In Cox analysis, the combination with BCMI was a strong independent predictor of mortality in these patients (hazard ratio: 1.48; confidence interval: 1.00–2.19; P = 0.048), even after adjustment. Although GB combination seemed to be also a predictor of death (hazard ratio: 2.67; confidence interval: 1.92–3.71; P < 0.001), when adjusted, the association remained no longer significant. Conclusion A new combination of parameters including protein intake, albumin and BCMI demonstrated significant associations with other nutrition and inflammation parameters as well as with mortality.

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“…The pattern of protein-energy wasting as the main nutritional complication among ESRD patients is changing. In a recent study, obesity was found in 43% of HD patients and at least a portion of them presented low LTI [21]. On the other hand, protein-energy wasting was uncommon, affecting only 4% [21].…”

Section: Resultsmentioning

confidence: 94%

Variables Associated with Low Muscle Mass Among End-Stage Renal Disease Patients Submitted to Hemodialysis: A cross-Sectional Study

Santos¹,

Grun²,

Oliveira³

et al. 2020

Preprint

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Background: We aimed to compare lean tissue index between patients with low and normal muscle strength in order to determine a cutoff to classify low muscle mass and find variables associated with low muscle mass among end-stage renal disease patients undergoing hemodialysis. Methods: We studied 245 end-stage renal disease patients on hemodialysis in the only two dialysis centers located in the north region of Ceará state, Brazil, in October 2019. Demographic, clinical, laboratory and anthropometric measurements were collected. Patients’ functional ability was assessed by the Brazilian version of the Stanford Health Assessment Questionnaire Disability Index. Bioimpedance analysis and handgrip testing were used, respectively, to evaluate lean tissue index and muscle strength. We classified low muscle mass according to muscle strength, and compared variables between patients with normal and low muscle mass. Variables that differed in the comparison were analyzed with a logistic regression model to detect independent predictors of low muscle mass. Results: According to a cutoff of less than or equal to 15 kg/m 2 of lean tissue index to classify low muscle mass, we found a prevalence of 41.2% of low muscle mass. Patients with low muscle mass presented higher prevalence of functional disability. In multivariate logistic regression (considering low muscle mass as a dependent variable), age (older), female gender, creatinine level, fat tissue index and abnormal waist-to-hip ratio were found to be independent predictors of low muscle mass. Conclusions: Older patients, women, patients with low creatinine, with high fat tissue index and with abnormal waist-to-hip ratio should be classified as at risk of low muscle mass. Dietary improvements, encouragement of resistance exercise and the use of androgens should be tried in this group of patients. Keywords: End-stage renal disease, Hemodialysis, Sarcopenia, Muscle mass, Muscle strength, Bioimpedance, Handgrip test

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Nutritional Status of Maintenance Dialysis Patients: Low Lean Body Mass Index and Obesity Are Common, Protein-Energy Wasting Is Uncommon

Cited by 21 publications

References 32 publications

Evaluation of body composition monitoring for assessment of nutritional status in hemodialysis patients

Evaluation of body composition monitoring for assessment of nutritional status in hemodialysis patients

Evaluating haemodialysis patient's nutritional status: Body mass index or body cell mass index?

Variables Associated with Low Muscle Mass Among End-Stage Renal Disease Patients Submitted to Hemodialysis: A cross-Sectional Study

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