Body composition is associated with clinical outcomes in patients with non–dialysis-dependent chronic kidney disease

Lin, Ting Yun; Peng, Ching Hsiu; Hung, Szu Chun; Tarng, Der Cherng

doi:10.1016/j.kint.2017.08.025

Cited by 73 publications

(54 citation statements)

References 54 publications

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“…The advantage of avoiding IDH occurrence by a high LTI remained significant, even after multivariable adjustment including C-reactive protein. Therefore, a higher lean body mass might have a specific protective role against unfavorable conditions in chronic kidney disease (CKD) [27]. In fact, sarcopenia as an independent predictor for poor outcomes is not unique to the CKD population.…”

Section: Discussionmentioning

confidence: 99%

Association of Body Composition and Intradialytic Hypotension in Hemodialysis Patients

et al. 2020

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Background/Aim: The relationship between body mass index (BMI) and intradialytic hypotension (IDH) has been inconsistently reported, but no further research has investigated the correlation between body composition and IDH so far. This study aimed to determine whether the lean tissue index (LTI), fat tissue index (FTI), or both derived from body composition monitoring (BCM) is associated with IDH defined as a nadir intradialytic systolic blood pressure of < 90 mm Hg and ≥3 episodes hypotension per 10 hemodialysis (HD) treatments in patients undergoing prevalent HD. Methods: The observational cohort study comprised 1,463 patients receiving thrice-weekly HD from 13 dialysis centers. LTI and FTI were assessed using a BCM machine, a multifrequency bioimpedance spectroscopy device. Unadjusted and multivariable adjusted logistic regression models were fit to estimate the association of body composition with the odds of developing IDH. Results: One hundred and seven patients (7.3%) were diagnosed as IDH. The difference in dialysis vintage, BMI, FTI, LTI, high-density lipoprotein cholesterol, and C-reactive protein between IDH and non-IDH groups was statistically significant (all p < 0.05). The preva-lence of diabetes among IDH patients was slightly higher than among non-IDH patients. In logistic regression models, low LTI and high FTI, but not high BMI were associated with greater odds of IDH ("high" as above median and "low" as below median). When patients were further stratified into 4 distinct body composition groups based on both the LTI and FTI, only the low LTI/high FTI group was connected with a significantly higher odds of IDH (OR 2.686, 95% CI 1.072-6.734; reference: low LTI/low FTI group). Conclusions: The LTI and FTI can provide better correlation of IDH occurrence than the BMI alone in prevalent HD patients. The low LTI/ high FTI appears to be most associated with IDH. An optimal body composition for preventing the occurrence of IDH needs to be determined.

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Section: Discussionmentioning

confidence: 99%

Association of Body Composition and Intradialytic Hypotension in Hemodialysis Patients

et al. 2020

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“…In epidemiological studies, adipose tissue wasting has been associated with an increased risk of death in different cachexia diseases. [28][29][30] The discovery about the ability of white adipose tissue to be turned towards the brown adipose phenotype with thermogenesis capacity, leading to increased energy expenditure and lipid mobilization, underlines the importance of this tissue in cachexia. Experimental data also suggest that this phenomenon appears before skeletal muscle atrophy.…”

Section: Body Weight and Body Compositionmentioning

confidence: 99%

Kidney cachexia or protein‐energy wasting in chronic kidney disease: facts and numbers

Koppe

Fouque

Kalantar-Zadeh

2019

J cachexia sarcopenia muscle

159

105

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Background Weight loss and homeostatic disturbances of both energy and protein balances are characteristics of several illnesses including cancer, heart failure, and chronic kidney disease (CKD). Different definitions have been used to describe this deleterious process. The term protein‐energy wasting (PEW) has been proposed for CKD patients by the International Society of Renal Nutrition and Metabolism . Methods We searched the publication in Medline from February 2008 to September 2018 using PEW or cachexia in their title. Results Since its inception, the term PEW has been exceptionally successful, highlighted by 327 original publications referenced in PubMed over 10 years. Using this classification, several studies have confirmed that PEW is among the strongest predictors of mortality in CKD patients [hazard ratio of 3.03; confidence interval of 1.69–5.26 in 1068 haemodialysis patients and 1.40 (1.04–1.89) in 1487 non‐dialysed patients across PEW stages 0 to 4]. Based on this classification, prevalence of PEW is 28% to 54% among 16 434 adults undergoing maintenance dialysis. PEW prevalence increases when renal function declines, that is, from <2% in CKD stages 1–2 to 11–54% in CKD stages 3–5. A more general definition of cachexia for all chronic diseases proposed by the Society on Sarcopenia, Cachexia and Wasting Disorders was also published concurrently. In the CKD area, we found 180 publications using ‘cachexia’ underlining that some confusion or overlap may exist. The definitions of PEW and cachexia are somewhat similar, and the main difference is that a loss of body weight >5% is a mandatory criterion for cachexia but supportive for PEW. Conclusions The recent understanding of cachexia physiopathology during CKD progression suggests that PEW and cachexia are closely related and that PEW corresponds the initial state of a continuous process that leads to cachexia, implicating the same metabolic pathways as in other chronic diseases. Despite the success of the definition of PEW, using a more uniform term such as ‘kidney disease cachexia’ could be more helpful to design future research through collaborative groups of researchers with focus on cachexia.

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“…Using waist circumference as surrogate of intra-abdominal or visceral fat shows that each 10-cm increase in waist circumference was associated with higher all-cause and cardiovascular death [23]. The superiority of survival advantages of (gaining) muscle compared to fat mass was confirmed by calculating the relation of lean to fat mass index which results in more favorable outcomes in patients with advanced CKD stages with a high lean/fat tissue index [24]. New insights of the meaning of muscle mass compared to fat mass in body weight gain comes from the "sarcopenia obesity" concept [25].…”

Section: Obesity In Advanced Ckd and Dialysis: A Paradoxmentioning

confidence: 99%

Preventive Nephrology: The Role of Obesity in Different Stages of Chronic Kidney Disease

Pommer¹

2018

Kidney Dis

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Background: Obesity is increasing worldwide and has become a nontraditional risk factor in chronic kidney disease (CKD). Summary: Obesity-related nephropathy may aggravate renal complications of the metabolic syndrome and progress to advanced CKD stages, while obesity in early stages of CKD is clearly related to the development of kidney disease. A high body mass index (BMI) in advanced CKD stages and dialysis is an advantage for survival (so called “obesity paradox”). A high lean body to fat mass index indicates a beneficial state of body composition. In contrast, loss of muscle mass with increasing fat mass causes “sarcopenia obesity,” which is related to unfavorable outcomes in renal replacement therapy. Obesity (BMI > 30–35) in renal transplant recipients is associated with a higher risk of complications such as delayed graft function, increased rates of rejection, and graft loss. While conservative management of morbid obesity is failing in most cases, bariatric surgery seems to be an option in some cases to improve renal complications in the early stage of CKD or in transplant candidates. Key Message: In conclusion, obesity is increasingly prevalent among CKD patients. Adequate management with respect to the specific role of obesity in different stages of CKD should be integrated in routine renal care.

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Body composition is associated with clinical outcomes in patients with non–dialysis-dependent chronic kidney disease

Cited by 73 publications

References 54 publications

Association of Body Composition and Intradialytic Hypotension in Hemodialysis Patients

Association of Body Composition and Intradialytic Hypotension in Hemodialysis Patients

Kidney cachexia or protein‐energy wasting in chronic kidney disease: facts and numbers

Preventive Nephrology: The Role of Obesity in Different Stages of Chronic Kidney Disease

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