Evaluation of body composition and nitrogen content of renal patients on chronic dialysis as determined by total body neutron activation

Cohn, S H; Brennan, B L; Yasumura, S; Vartsky, D.; Vaswani, A.; Ellis, Kathryn

doi:10.1093/ajcn/38.1.52

Cited by 60 publications

(14 citation statements)

References 9 publications

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“…Our results stand in contradistinction from a study performed several decades ago utilizing 40 K analysis in HD patients and matched controls; however, subjects were receiving regularly scheduled dialysis [15]. It is evident in the best of circumstances when patients receive maintenance HD that muscle wasting occurs in patients with ESRD, and it has been attributed to a number of metabolic changes including insulin resistance, presence of acidosis and inflammation [16,17].…”

Section: Discussioncontrasting

confidence: 62%

Adverse Effects of Sporadic Dialysis on Body Composition

Workeneh

Shypailo

DeCastro

et al. 2015

Nephron

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Objective: The aim of this study is to analyze the body composition of patients receiving emergent dialysis and compare their body cell mass (BCM) and fat-free mass (FFM) with those of normal subjects. The care of patients receiving sporadic, emergent dialysis treatment is a growing public health concern and the magnitude of muscle wasting that occurs in this population is not known. Design and Methods: We used a cross-sectional design with matching to determine differences in total body potassium - an indicator of both BCM and FFM - between emergent dialysis patients and healthy normal subjects. We studied 22 subjects using a ⁴⁰K counter that measures BCM and FFM and compared them to controls after matching with sex, height and weight. Results: In the matched comparison, BCM and FFM were significantly lower in subjects with end-stage renal disease (ESRD). Unadjusted BCM was 4.7 kg lower and FFM was 8.8 kg lower for those with ESRD compared to those without ESRD (p < 0.001, p < 0.001, respectively). Comparison with unmatched controls who underwent ⁴⁰K analysis also revealed significantly lower BCM (4.1 kg) and FFM (7.7 kg) in the ESRD subjects (p = 0.004). After adjusting for age, height, weight and gender, BCM and FFM were lower by 4.2 and 7.8 kg, respectively (p < 0.001). Repeated observations were available for a subset of ESRD subjects, and the rate of FFM loss over time was significant, with the ESRD subjects demonstrating 2.2 kg per year decline (p = 0.01). Conclusion: We conclude that among other consequences, muscle wasting indicated by decline in BCM and FFM is a significant concern in the growing emergent dialysis population.

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Section: Discussioncontrasting

confidence: 62%

Adverse Effects of Sporadic Dialysis on Body Composition

Workeneh

Shypailo

DeCastro

et al. 2015

Nephron

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“…Sophisticated techniques, such as neutron activation analysis or total body potassium, are accurate and reliable methods but are expensive and not available for clinical purposes; 39,40 anthropometric measurements also accurately re¯ect nutritional status and body composition in dialysis, 13,41 but are time-consuming and not practical to take on a routine basis. On the other hand, clinical and laboratory parameters are easy to collect but imprecise.…”

Section: Discussionmentioning

confidence: 99%

Abnormalities of bioimpedance measures in overweight and obese hemodialyzed patients

et al. 2001

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BACKGROUND:The body composition in overweight and obese hemodialyzed patients (HD) remains ill-de®ned. This study evaluates in HD patients the in¯uence of body size, as indicated by body mass index (BMI, kgam 2 ), on body composition by measuring bioimpedance analysis (BIA)-derived variables (phase angle (PA), fat-free mass (FFM) and body cell mass (BCM). METHODS: We studied 50 Caucasian patients (mean age 62.8 AE 9.2 y) on standard bicarbonate hemodialysis for at least 12 months who regularly achieved dry weight in post-HD, received similar dialysis doses and were free from in¯ammationainfec-tion. Thirty-eight gender-and age-matched healthy subjects were included as controls (CON). Both HD and CON were divided into three groups on the basis of their BMI(kgam 2 ) 18.5 ± 24.9, normal-weight (NW); 25 ± 29.9, overweight (OW); and !30, obese (OB). In HD patients, BIA was performed 30 min after the end of dialysis. RESULTS: Seven patients were obese (12%) while 16 were overweight (32%); in CON, 12 were obese (31%) and 12 overweight (31%). BIA-measured extracellular water was comparable in all groups. PA, which was similar in normal-weight HD and CON (6.2 AE 0.9 and 6.3 AE 0.8 ), decreased in OW-and OB-HD patients (5.3 AE 1.0 and 5.2 AE 0.6 , respectively; P`0.05 vs NW-HD) while it was unchanged in OW-and OB-CON (6.1 AE 0.8 and 5.9 AE 0.5 , P`0.05 vs respective HD groups). In OW and OB patients, the lower PA values were coupled with a major reduction of BIA-derived percentage BCM and FFM (P`0.05 vs NW-HD, and vs OW-and OB-CON). In patients, PA and BCM correlated with anthropometry-measured FFM. Of note, serum albumin and protein catabolic rate were signi®cantly reduced in OB patients. CONCLUSION: In overweight and obese HD patients, BIA-derived FFM, BCM and PA are signi®cantly lower with respect to normal-weight patients and BMI-matched controls. These abnormalities of body composition are coupled with reduction of anthropometric measures of lean mass and a decrease of protein intake that, however, becomes signi®cant only in the obese. We therefore suggest that overweight and obese HD patients are at risk of protein malnutrition in spite of excessive energy intake. BIA may be considered as a useful diagnostic tool to detect such a condition early.

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“…As yet, studies on only small numbers of patients using this technique have been published. Cohn et al [8] found a reduction in total body protein in 15 haemodialy sis patients, but this did not reach statistical significance. Williams et al [9] found a significant 9% reduction in total body protein in 43 patients dialysed for up to 5 years, but normal values in 8 patients dialysed for over 5 years.…”

Section: Introductionmentioning

confidence: 91%

Anthropometry Underestimates Body Protein Depletion in Haemodialysis Patients

Rayner

Stroud²,

Salamon

et al. 1991

Nephron

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The body composition of 62 haemodialysis patients (41 males) and 63 controls (30 males) was assessed using anthropometry and in vivo neutron activation analysis of body nitrogen. There was no significant difference between patients and controls in body mass index (BMI) and percentage body fat. Arm muscle circumference was significantly reduced in males. Lean body mass was strongly correlated with body nitrogen in controls (r = 0,951) but less so in patients (r = 0,876). The mean standardised body nitrogen index (NI) was reduced in male patients by 13% (95% confidence interval -9 to -17%) and in females by 4% (95% confidence interval + 4 to -12%). Of the 16 patients with a NI below the control range, arm muscle circumference was below the control range in only 3 and BMI less than 18 kg/m² in 2. NI was correlated negatively with the duration of renal replacement therapy, duration of haemodialysis, the number of previous failed transplants and the total dose of steroids received but not with current energy or protein intakes. Steroid dose was the only significant independent variable. Anthropometry underestimates body protein depletion in haemodialysis patients and the degree of protein loss is related to the cumulative dose of corticosteroids previously received.

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Evaluation of body composition and nitrogen content of renal patients on chronic dialysis as determined by total body neutron activation

Cited by 60 publications

References 9 publications

Adverse Effects of Sporadic Dialysis on Body Composition

Adverse Effects of Sporadic Dialysis on Body Composition

Abnormalities of bioimpedance measures in overweight and obese hemodialyzed patients

Anthropometry Underestimates Body Protein Depletion in Haemodialysis Patients

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