Low body cell mass index in hemodialysis patients: Association with clinical parameters and survival

Abstract

Introduction: Body cell mass (BCM) is a useful nutritional marker and is not affected by changes in the hydration status that commonly occur in hemodialysis (HD) patients. This study aimed to examine the association between body cell mass index (BCMI) and nutritional parameters, as well as its relationship with long-term survival in these patients.Methods: This longitudinal prospective multicenter study followed a cohort of patients in HD for 24 months. The clinical parameters of 2527 patients (mean age 70.3 AE 14.6 years, 55.8% male and mean HD vintage 58 (IQR:33-95) months) were measured and their body composition parameters were assessed by a body composition monitor before the HD session. BCM was converted to BCMI (BCM/height 2 ) and, taking into account the mean value (6.4 AE 2.1 kg/m 2 ), we split our study population into 2 groups: G1 (BCMI <6.4 kg/m 2 ; n = 1366) and G2 (BCMI ≥ 6.4 kg/m 2 ; n = 1161). All statistical tests were performed using SPSS 20.0 software. A P value lower than 0.05 was considered statistically significant.Findings: Patients with a BCMI <6.4 kg/m 2 displayed higher age (P < 0.001), dialysis adequacy (Kt/V) (P < 0.001), total cholesterol (TC) (P = 0.033), high-density lipoprotein cholesterol (HDL-C) (P < 0.001), relative overhydration (overhydration/extracellular water [OH/ECW]) (P < 0.001), CRP (P < 0.001), fat tissue index (FTI) (P < 0.001) and lower normalized protein equivalent of nitrogen appearance (nPNA) (P < 0.001), albumin (P < 0.001), serum creatinine (P < 0.001), creatinine index (P < 0.001), potassium (P < 0.001), phosphorus (P < 0.001), calcium/phosphorus product (Ca X P) (P < 0.001), lean tissue index (LTI) (P < 0.001) and body mass index (BMI) (P = 0.046). The Kaplan-Meier survival curve showed a significantly better survival in female and male patients with BCMI ≥6.4 kg/m 2 (P = 0.001 and P < 0.001, respectively). In the cox regression analysis, a significantly higher mortality risk was observed in G1 patients (P = 0.001).Discussion: Our study showed that a low BCMI was a mortality predictor and was associated with worse nutritional parameters in patients undergoing HD.

The Relationship of Malnutrition With Cognitive Function in the Older Chinese Population: Evidence From the Chinese Longitudinal Healthy Longevity Survey Study

“…Evidence suggested that serum albumin can combine with amyloid-β and can reduce its neurotoxicity by inhibiting its aggregation and fibrosis, thus preventing further progression of cognitive decline ( Stanyon and Viles, 2012 ). Meanwhile, it is reported that BMI has an effect on energy metabolism through regulating body cell mass, which is one of the key factors to reflect nutritional status ( Oliveira et al, 2020 ). According to previous studies, overweight old people were found to have a lower risk of cognitive impairment or dementia compared with under or normal weight ( Hou et al, 2019 ; Li et al, 2020 ).…”

The early prognostic value of the 1-4-day BCM/PA trend after admission in neurocritical patients

“…BCM is an important indicator in the analysis of human body composition; it is de ned as the total mass of metabolically active, viable, functional cells [40] . Increasing evidence shows that BCM is closely related to the in ammatory response in cancer patients, elderly patients, patients with chronic diseases, and hemodialysis patients, and it has an impact on patients' clinical outcomes [41][42][43][44] . Toshimi [45] et al con rmed that low preoperative BCM (BCM ≤ 23 kg) was a risk factor for sepsis and death from infection after liver transplantation.…”

“…However, the speci city of these indicators is not high [23][24][25][26] , and most studies are based on a one-time cutoff point and lack observations of dynamic change trends; thus, the predictive performance of these indicators is controversial, and they are not suitable as early and effective prognostic indicators for neurocritical patients. In recent years, studies have con rmed that relevant indicators measured by bioelectrical impedance analysis (BIA), such as phase angle (PA), BCM, and hydration status, are associated with in ammatory responses and a poor prognosis in patients who are elderly, have cancer, are undergoing hemodialysis, or are critically ill [27][28][29][30][31] . They are expected to become novel indicators for predicting patient prognosis, but their predictive e cacy needs to be further veri ed.…”

Body Composition Analysis as a Predictor of Prognosis for Patients With Acute Kidney Injury Requiring Kidney Replacement Therapy

“…Both LTI and BCMI are associated with resting energy expenditure. 36,37 In terms of theory, BCMI reflects the most metabolically active part of fat-free mass, which is not affected by hydration status, and should perform better than LTI. Our results show that BCMI performed similarly to LTI.…”