Impact of phase angle and sarcopenia estimated by bioimpedance analysis on clinical prognosis in patients undergoing hemodialysis

Abstract

Bioimpedance analysis (BIA) has been widely used in the evaluation of body composition in patients undergoing maintenance hemodialysis. We conducted this study to evaluate impact of phase angle (PA) and sarcopenia measured by BIA on clinical prognosis in these patients.This longitudinal retrospective study enrolled patients who underwent hemodialysis between January 2016 and March 2019. The patients were stratified into higher (> 4°) and lower ( 4.0°) PA groups. Sarcopenia was defined when the appendicular skeletal muscle mass was < 20 kg in men and < 15 kg in women.Of the 191 patients, 63.4% were men. The mean age was 64.2 ± 12.4 years. The lower PA group was older, had a higher proportion of women, a lower body mass index, lower albumin, cholesterol, uric acid, and phosphorus levels, and a higher incidence of history of coronary artery disease than the higher PA group. Linear regression analysis revealed that PA was significantly associated with body mass index (B = 0.18, P = .005), serum albumin (B = 0.23, P = .001), and creatinine levels (B = 0.32, P < .001). During a median follow-up of 16.7 months, 14.1% (n = 27) of patients experienced major adverse cardiovascular events and 11.0% (n = 21) died. Kaplan-Meier survival analysis showed that the higher PA group had significantly better survival, regardless of sarcopenia. Multivariate Cox analyses revealed that lower PA (0.51 [0.31-0.85], P = .010), higher IDWG (1.06 [1.01-1.12], P = .028) and C-reactive protein level (1.01 [1.01-1.02], P < .001), and a history of coronary artery disease (3.02 [1.04-8.77], P = .042) were significantly related to all-cause mortality after adjusting for other covariates.PA measured by BIA was an independent factor in the prediction of mortality in maintenance hemodialysis patients, regardless of sarcopenia. Intervention studies are needed to confirm if the improvement in PA is associated with better clinical outcome.Abbreviations: ASMM = appendicular skeletal muscle mass, BIA = bioimpedance analysis, BMI = body mass index, CAD = coronary artery disease, HD = hemodialysis, MACE = major adverse cardiovascular events, MHD = maintenance hemodialysis, PA = phase angle, PEW = protein-energy wasting, SMI = skeletal muscle mass index.

Low Lean Tissue Index and Muscle Strength Combined with High Fat Tissue Index Are Associated with Cardiovascular Disease-Related Hospitalisation in Patients on Haemodialysis

“…Among patients with HD, Kim et al [22] reported that the risk of CVD events was three times higher in those who had low muscle mass than in the control group. Conversely, another study on patients with HD found that appendicular skeletal muscle mass, which was measured by bioimpedance analysis, was not a significant risk factor for major adverse cardiovascular events [23]. Furthermore, ratio, albumin, uric acid, FTI (when LTI being considered as an independent variable), LTI (when FTI being considered as an independent variable).…”

“…Among patients with HD, Kim et al [22] reported that the risk of CVD events was three times higher in those who had low muscle mass than in the control group. Conversely, another study on patients with HD found that appendicular skeletal muscle mass, which was measured by bioimpedance analysis, was not a significant risk factor for major adverse cardiovascular events [23]. Furthermore, although other reports showed more consistent associations between loss of muscle strength and mortality [13, 24–27], the importance of low muscle mass as an independent predictor of mortality in dialysis populations remains controversial [22, 23].…”

“…Conversely, another study on patients with HD found that appendicular skeletal muscle mass, which was measured by bioimpedance analysis, was not a significant risk factor for major adverse cardiovascular events [23]. Furthermore, although other reports showed more consistent associations between loss of muscle strength and mortality [13, 24–27], the importance of low muscle mass as an independent predictor of mortality in dialysis populations remains controversial [22, 23]. In this study on patients on HD, both muscle mass and strength were independently associated with CVD-related hospitalisation in men; however, only low muscle mass was a risk factor for this clinical outcome in women.…”

“…Cardiorenal Med 2023;13:363-371 DOI: 10.1159/000534399 although other reports showed more consistent associations between loss of muscle strength and mortality [13,[24][25][26][27], the importance of low muscle mass as an independent predictor of mortality in dialysis populations remains controversial [22,23]. In this study on patients on HD, both muscle mass and strength were independently associated with CVD-related hospitalisation in men; however, only low muscle mass was a risk factor for this clinical outcome in women.…”

Molecular, Metabolic, and Nutritional Changes after Metabolic Surgery in Obese Diabetic Patients (MoMen): A Protocol for a Multicenter Prospective Cohort Study

“…In critical illness states, a weakened membrane integrity, a reduced cell count, and a modified hydration status lead to a reduced PhA. These situations correlate with an increased mortality rate and the length of the hospital stay [ 52 , 53 , 54 ]. While many studies have been conducted on healthy subjects, obese individuals, the elderly population, and hemodialysis patients, we need more data on metabolic surgery diabetes remission patients [ 55 , 56 ].…”