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

Valente, Ana; Caetano, Cristina; Oliveira, Telma; Garagarza, Cristina

doi:10.1111/nep.13527

Cited by 10 publications

(16 citation statements)

References 37 publications

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“…Body cell mass, which corresponds to fat-free mass without bone mineral mass and extracellular water, is the metabolically active compartment of the body. 15 We found that poor body cell mass index was independently associated with hypomagnesemia. 10,15 Another advantage of the body cell mass index is that this compartment excludes extracellular water, avoiding possible masking of the nutritional status.…”

Section: Discussionmentioning

confidence: 70%

“…18 In peritoneal dialysis patients, low serum Mg levels are associated with poorer nutritional status, deteriorating cellular health, increased inflammation, and lower BMI. 10,15 Another advantage of the body cell mass index is that this compartment excludes extracellular water, avoiding possible masking of the nutritional status. Body cell mass, which corresponds to fat-free mass without bone mineral mass and extracellular water, is the metabolically active compartment of the body.…”

Section: Discussionmentioning

confidence: 99%

“…14,15 The body cell mass index was then calculated as body cell mass/height 2 (kg/m 2 ). Body composition analysis was performed on the day of blood sampling.…”

Section: Methodsmentioning

confidence: 99%

“…We measured extracellular water, lean tissue index, fat tissue index, and body cell mass, which is fat-free mass without the bone mineral mass and extracellular water. 14,15 The body cell mass index was then calculated as body cell mass/height 2 (kg/m 2 ). 15 Normal lean tissue index and fat tissue index were defined as levels between the 10th and 90th percentiles of the normal lean tissue index and fat tissue index distribution of the age-matched and sex-matched healthy population, respectively.…”

Section: Methodsmentioning

confidence: 99%

“…14,15 The body cell mass index was then calculated as body cell mass/height 2 (kg/m 2 ). 15 Normal lean tissue index and fat tissue index were defined as levels between the 10th and 90th percentiles of the normal lean tissue index and fat tissue index distribution of the age-matched and sex-matched healthy population, respectively. 16 A low lean tissue index was defined as a lean tissue index <10% of that of normal subjects, and a low fat tissue index was defined as a fat tissue index <10% of that of normal subjects.…”

Section: Methodsmentioning

confidence: 99%

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Relationship of serum magnesium level with body composition and survival in hemodialysis patients

Mizuiri¹,

Nishizawa²,

Yamashita³

et al. 2019

Hemodialysis International

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Introduction: A relationship between serum magnesium (Mg) and body composition parameters has not been reported in hemodialysis (HD) patients. We aimed to clarify whether serum Mg has any association with body composition parameters, or survival in HD patients.Methods: This study included 215 consecutive maintenance HD patients. Laboratory data collection and postdialysis body composition analysis were performed at baseline. The patients were divided based on baseline serum Mg level tertiles (low, medium, and high Mg groups). Kaplan-Meier survival, logistic regression analyses and Cox proportional hazard analyses were conducted.Findings: Among all patients, the median age and dialysis vintage were 73 (65-81) years and 44 (8-96) months, respectively. The serum Mg levels were < 2.3, 2.3-2.5, and > 2.5 mg/dL for the low (n = 67), middle (n = 76), and high (n = 72) Mg groups, respectively. Compared to other groups, low Mg group showed significantly higher age and C-reactive protein levels, but lower serum albumin, normalized protein catabolic rates and frequency of on-line hemodiafiltration. The low, middle, and high Mg groups differed significantly regarding body cell mass (fat-free mass without bone mineral mass and extracellular water) index (BCMI): [5.6 (4.2-6.8), 6.0 (4.8-8.1), 6.7 (4.9-7.5) kg/m 2 , respectively] and overhydration/extracellular water ratio (OH/ECW) [11.7 (4.5-21.9), 4.8 (1.0-14.1), 8.5 (−0.5-15.0) %, respectively] but not regarding body mass index, lean tissue index, fat tissue index. Hypomagnesemia was significantly associated with BCMI [odds ratio (OR) [95% confidence interval (CI)]: 0.85 [0.73-1.00] and OH/ECW (OR [95% CI]: 1.03 [1.01-1.05]), respectively. Kaplan-Meyer 3-year survival rates were 53.6%, 69.7%, and 71.7% in low, middle, and high Mg groups, respectively. However, hypomagnesemia was not significantly associated with 3-year allcause mortality independent of age, serum albumin and C-reactive protein.Discussion: Hypomagnesemia was associated with lower BCMI, more pronounced OH/ECW and poorer Kaplan-Meier 3-year cumulative survival, but was not an independent risk factor for mortality in HD patients.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

“…14,15 The body cell mass index was then calculated as body cell mass/height 2 (kg/m 2 ). Body composition analysis was performed on the day of blood sampling.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Relationship of serum magnesium level with body composition and survival in hemodialysis patients

Mizuiri¹,

Nishizawa²,

Yamashita³

et al. 2019

Hemodialysis International

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Comparative Performance of Body Composition Parameters in Prediction of Death in Hospitalized Patients on Maintenance Hemodialysis: A Cohort Study

Yan

Zhang

et al. 2020

Sci Rep

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We compared the prognostic value of nutritional or volumetric parameters measured by body composition in hospitalized patients on maintenance hemodialysis. We conducted a cohort study to assess the association of different parameters of body composition with all-cause mortality in inpatients admitted to our nephrology department from January 2014 to December 2016. Of the 704 study patients, 160 (22.7%) died during a median follow-up of 33 months. In multivariate adjusted Cox models, higher ratio of extracellular water to body cell mass (ECW/BCM) (adjusted HR per 1-SD, 1.49; 95% CI, 1.19 to 1.85), lower lean tissue index (LTI) (adjusted HR per 1-SD, 0.70; 95% CI, 0.57 to 0.86) and lower body cell mass index (BCMI) (adjusted HR per 1-SD, 0.70; 95% CI, 0.58 to 0.85) were associated with a significantly greater risk of death. When these parameters were added to the fully adjusted model, BCMI performed best in improving the predictability for all-cause mortality (integrated discrimination improvement = 0.02, P = 0.04; net reclassification index = 0.11, P = 0.04). Among body composition indexes, ECW/BCM was the most relevant fluid volume indices to mortality and BCMI and LTI were the most relevant nutritional status indices to mortality in maintenance hemodialysis patients. End-stage renal disease (ESRD) has become one of the major health problems in the world. In 2010, it was estimated that 284 individuals per million population were undergoing maintenance dialysis throughout the world 1 , and the number of dialysis patients is growing at an alarming rate 2-5. Dialysis is the major treatment for ESRD and brings a heavy economic burden to all countries 6. Despite this, dialysis patients still have poor prognosis 5,7. The main risk factors for the mortality includes vascular access, cardiovascular complications, cerebrovascular complications, infection, anemia, mineral metabolic disorders, renal osteopathy, fluid overload (FO) and malnutrition 7,8. Bioelectrical impedance analysis-based body composition analysis is widely used and accepted as an ideal tool for assessing fluid volume and nutritional status in maintenance dialysis patients 9. It is easy-to-use, safe, noninvasive, repeatable and comprehensive. It has both anthropometric parameters in assessing fluid volume [such as overhydration (OH) 10 , OH/extracellular water (OH/ECW) 8,11-14 , the ratio of extracellular water to intracellular water (ECW/ICW) 15 , the ratio of extracellular water/body cell mass (ECW/BCM) 16,17 ] and nutrition status [such as lean tissue index (LTI) 11,18-23 , fat tissue index (FTI) 11,18 , body cell mass index (BCMI) 24,25 , BCM/weight 26 ]. However, it is still unclear which nutritional or volumetric parameters of body composition, measured by bioelectrical impedance, have the greatest prognostic value in maintenance hemodialysis patients. We designed this cohort study to assess and compare the association of different parameters in body composition with all-cause medium-term mortality in hemodialysis patients.

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Phase angle is a useful predicting indicator for protein-energy wasting and cardiovascular risk among maintenance hemodialysis patients

Wang,

Chen,

Zhang

et al. 2024

Sci Rep

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Protein-energy wasting (PEW) is a major contributor to the high mortality among maintenance hemodialysis (MHD) patients. Cardiovascular disease (CVD) is the leading cause of death in dialysis patients, and PEW can significantly increase cardiovascular mortality in MHD patients. Previous studies have confirmed that PA may be a good objective indicator for determining the nutritional status and prognosis of MHD patients. Our study aimed to determine the predictive value of phase angle (PA) as detected by bioelectrical impedance analysis (BIA) on PEW and cardiovascular (CV) risk among MHD patients. Our retrospective observational study involved 161 adult patients with HD. The Cardiovascular risk score is a risk model based on the Japan Dialysis Outcome and Practice Patterns Study (J-DOPPS). We established LASSO logistic regression analysis model to identify key parameters related to body composition that can predict PEW in MHD patients. The area under the curve (AUC) values for PA, appendicular skeletal muscle mass index (ASMI), body cell mass (BCM), and mid-arm circumference (MAC) in predicting PEW in male MHD patients were relatively large, with 0.708, 0.674, 0.663, and 0.735, respectively.The predicted PEW values of these parameters were slightly lower in female patients than in men. We incorporated PA, ASMI, BCM, and MAC into a model that predicted the incidence of PEW in maintenance hemodialysis patients using LASSO technology. We discovered that the model predicted a greater AUC of PEW occurrence than any single factor, 0.877 for men and 0.76 for women. The results of the univariate logistic regression analysis showed that the low PA tertile array group had a greater incidence of PEW than the high PA group (P < 0.001). Additionally, we also found that lower PA was associated with higher CV risk scores. The PA detected by bioelectrical impedance analysis could predict the risk of PEW and cardiovascular events among patients with MHD. When used in conjunction, PA, ASMI, BCM, and MAC have a high diagnostic efficacy for PEW in patients on maintenance hemodialysis.

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

Cited by 10 publications

References 37 publications

Relationship of serum magnesium level with body composition and survival in hemodialysis patients

Relationship of serum magnesium level with body composition and survival in hemodialysis patients

Comparative Performance of Body Composition Parameters in Prediction of Death in Hospitalized Patients on Maintenance Hemodialysis: A Cohort Study

Phase angle is a useful predicting indicator for protein-energy wasting and cardiovascular risk among maintenance hemodialysis patients

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