Bioimpedance phase angle predicts muscle function, quality of life and clinical outcome in maintenance hemodialysis patients

Beberashvili, Ilia; Azar, Ada; Sinuani, Inna; Shapiro, Gregory; Feldman, Leonid; Stav, Kobi; Sandbank, Judith; Averbukh, Zhan

doi:10.1038/ejcn.2014.67

Cited by 114 publications

(92 citation statements)

References 40 publications

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“…Inflammation can cause an increased capillary leak and increased ECW, and inflammation can also lead to a reduction in cell mass, and therefore, ICW [34] . Our results are in keeping with other reports using single frequency bioimpedance, demonstrating an association with overhydration and increased mortality [35] , and others recording an association between an increased markers of inflammation and muscle weakness [33,36] .…”

Section: Discussionsupporting

confidence: 93%

Measurement of Muscle Strength in Haemodialysis Patients by Pinch and Hand Grip Strength and Comparison to Lean Body Mass Measured by Multifrequency Bio-Electrical Impedance

Omichi¹,

Srivareerat²,

Panorchan³

et al. 2016

Ann Nutr Metab

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Background: Muscle weakness is a risk factor for mortality in haemodialysis (HD) patients; we wished to determine whether measuring the composition of the arm with bioimpedance was associated with arm muscle strength. Methods: We measured pinch strength (PS) and hand grip strength (HGS) in 250 adult HD patients with corresponding post-dialysis multifrequency bioelectrical assessments with segmental body analysis. Results: Mean age 64.0 ± 15.6, 66% male and 45.6% diabetic. The maximum HGS in the dominant or non-fistula arm was 18.9 ± 9.2 kg and PS 4.09 ± 1.96 kg respectively, with a correlation of r = 0.80, p < 0.001. HGS was associated with body cell mass (β 0.37, p < 0.001) and PS with appendicular muscle mass (β 0.06, p < 0.001). Both HGS and PS were independently associated with the ratio of extracellular water (ECW) to total body water (TBW); β -139.5, p = 0.024, β -44.8, p < 0.001 in the arm. The presence of an arterio-venous fistula increased the ECW/TBW ratio in the arm from 0.383 ± 0.009 to 0.390 ± 0.012, p < 0.05. Conclusion: Muscle strength measured by HGS and PS was associated with both markers of whole body and segmental body composition within the arm, particularly ECW/TBW. Bioimpedance measurements and assessment of muscle strength should be measured in the non-fistula arm.

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Section: Discussionsupporting

confidence: 93%

Measurement of Muscle Strength in Haemodialysis Patients by Pinch and Hand Grip Strength and Comparison to Lean Body Mass Measured by Multifrequency Bio-Electrical Impedance

Omichi¹,

Srivareerat²,

Panorchan³

et al. 2016

Ann Nutr Metab

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“…Body composition in patients with CKD is characterized by excess ECW content associated with sodium retention and a decreased body cell mass with malnutrition, and we speculated that cell volume might be associated with nutritional status and indicate the reserve capacity for volume overload in patients with fluid volume imbalance [40,41]. In fact, the bioimpedance phase angle, as a measure of nutritional status [42,43], was associated with GNRI levels. Hyperphosphotemia is an independent risk factor for adverse outcomes in patients with CKD [44], and serum phosphorus level depends on protein intake [5].…”

Section: Discussionmentioning

confidence: 99%

Association between Low Dietary Protein Intake and Geriatric Nutrition Risk Index in Patients with Chronic Kidney Disease: A Retrospective Single-Center Cohort Study

et al. 2016

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Reduced dietary protein intake in malnourished patients with chronic kidney disease (CKD) may be associated with adverse clinical outcomes, which may mask any efficacy of a low-protein diet. The study included 126 patients with CKD who attended a dedicated dietary counseling clinic in 2005–2009 and were systematically followed until January 2015. Of these patients, 20 (15.9%) had moderate or severe nutrition-related risk of geriatric nutritional risk index (GNRI) < 92; these patients were more likely to be older, have a greater proteinuria, and have lower body mass index and serum albumin concentration. Dietary protein intake was significantly lower in older patients (r = −0.33, p < 0.001) and those with lower glomerular filtration rate (r = 0.47, p < 0.001). The non-protein to nitrogen calorie ratio was independently associated with GNRI. Reduced GNRI was significantly associated with mortality (hazard ratio (HR) = 4.94; 95% confidence interval (CI) = 1.61–15.42, p = 0.012) and cardiovascular events (HR = 9.37; 95% CI = 2.49–37.34, p = 0.006), but not with adverse renal outcomes. Restricting protein intake may be harmful to patients with any nutrition-related risk, suggesting that improvement of nutritional status should be a high priority.

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“…Additionally, PhA has been associated with a number of clinical conditions, such as advanced liver fibrosis in patients chronically infected with hepatitis C virus [3], cancer [4], peritoneal dialysis [4], malnutrition [5], low muscle mass [6,7], and higher mortality in patients with several diseases [8][9][10]. Recently, in hemodialysis patients, it was also observed that PhA values were associated with muscle function and overall quality of life [11].…”

Section: Introductionmentioning

confidence: 99%

High C-reactive protein instead of metabolic syndrome is associated with lower bioimpedance phase angle in individuals clinically screened for a lifestyle modification program

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Gondo

et al. 2017

Nutrire

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Background: Phase angle (PhA) value is a useful tool for identifying cell membrane integrity dysfunction. It is known that metabolic syndrome (MetS) increases oxidative stress and inflammation; and consequently can promote cellular damage. We hypothesized that MetS and inflammatory blood markers could be associated with lower PhA values. Therefore, the aim of this study was to identify the association of PhA values with MetS and blood markers in individuals clinically screened for a lifestyle modification program. Methods: In a cross-sectional study, 417 selected subjects (76 men and 341 women, 53.9 ± 9.4 years old) were evaluated. Assessments included clinics, anthropometric measures, body composition by bioimpedance, and laboratory blood markers, including plasma lipids, glucose, and C-reactive protein concentrations. According to the PhA median values, subjects were classified in low (≤6.3°) and high (>6.3°) PhA groups. Results: Subjects with lower PhA values were older and showed lower body mass index, waist circumference, muscle mass index, creatinine, and uric acid; and higher gamma-GT and HDL cholesterol. Neither the presence of MetS nor the presence of the increasing number of MetS components was associated with PhA values. The logistic regression analysis adjusted for age, gender, body mass index, and muscle mass index showed that higher C-reactive protein concentrations (>3.0 mg/L) increased the odds of low PhA values (OR = 1.62; CI = 1.01-2.60). Conclusion: Higher C-reactive protein concentrations increased the odds of low PhA independently of the presence of MetS. Additionally, contrary to our hypothesis, MetS was not associated with PhA values.

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Bioimpedance phase angle predicts muscle function, quality of life and clinical outcome in maintenance hemodialysis patients

Abstract: For the MHD population, PA emerged as a useful predictor for impaired muscle function, health-related Qol, upcoming hospitalizations and mortality.

Cited by 114 publications

References 40 publications

Measurement of Muscle Strength in Haemodialysis Patients by Pinch and Hand Grip Strength and Comparison to Lean Body Mass Measured by Multifrequency Bio-Electrical Impedance

Measurement of Muscle Strength in Haemodialysis Patients by Pinch and Hand Grip Strength and Comparison to Lean Body Mass Measured by Multifrequency Bio-Electrical Impedance

Association between Low Dietary Protein Intake and Geriatric Nutrition Risk Index in Patients with Chronic Kidney Disease: A Retrospective Single-Center Cohort Study

High C-reactive protein instead of metabolic syndrome is associated with lower bioimpedance phase angle in individuals clinically screened for a lifestyle modification program

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