Mid-Arm Muscle Circumference and Quality of Life and Survival in Maintenance Hemodialysis Patients

Abstract

Background and objectives: Maintenance hemodialysis (MHD) patients with larger body or fat mass have greater survival than normal to low mass. We hypothesized that mid-arm muscle circumference (MAMC), a conveniently measured surrogate of lean body mass (LBM), has stronger association with clinical outcomes than triceps skinfold (TSF), a surrogate of fat mass.Design, settings, participants, & measurements: The associations of TSF, MAMC, and serum creatinine, another LBM surrogate, with baseline short form 36 quality-of-life scores and 5-year survival were examined in 792 MHD patients. In a randomly selected subsample of 118 subjects, LBM was measured by dual-energy x-ray absorptiometry.Results: Dual-energy x-ray absorptiometry-assessed LBM correlated most strongly with MAMC and serum creatinine. Higher MAMC was associated with better short form 36 mental health scale and lower death hazard ratios (HRs) after adjustment for case-mix, malnutrition-inflammation-cachexia syndrome, and inflammatory markers. Adjusted death HRs were 1.00, 0.86, 0.69, and 0.63 for the first to fourth MAMC quartiles, respectively. Higher serum creatinine and TSF were also associated with lower death HRs, but these associations were mitigated after multivariate adjustments. Using median values of TSF and MAMC to dichotomize, combined high MAMC with either high or low TSF (compared with low MAMC/TSF) exhibited the greatest survival, i.e., death HRs of 0.52 and 0.59, respectively.Conclusions: Higher MAMC is a surrogate of larger LBM and an independent predictor of better mental health and greater survival in MHD patients. Sarcopenia-correcting interventions to improve clinical outcomes in this patient population warrant controlled trials.

The Obesity Paradox and Mortality Associated With Surrogates of Body Size and Muscle Mass in Patients Receiving Hemodialysis

“…To verify the association between the serum creatinine concentration and LBM that was shown previously, 15,16,22 we carried out a validation study within the NIED (Nutritional and Inflammatory Evaluation in Dialysis) study, in 747 randomly selected patients receiving HD at 8 DaVita dialysis clinics in the Los Angeles South Bay area. Near-infrared interactance and DEXA were used as the reference standard for LBM measurements (for more details on the creatinine validation substudy, see the eDocument and eTable in the Supporting Online Material [a link to which is provided at the end of this article], the NIED study Web site at http://www.NIEDstudy.org, and previous studies 13,[22][23][24] ).…”

IL-6 Levels, Nutritional Status, and Mortality in Prevalent Hemodialysis Patients

“…Using dual-energy x-ray absorptiometry (DEXA) as a gold standard, MAMC recently was validated as a correlate of lean body mass in ESRD patients on maintenance hemodialysis, and is associated with survival advantage in these patients, especially in those with lower BMI (31).…”

Obesity and kidney disease: hidden consequences of the epidemic

“…Indeed, studies that separated the effects of a higher waist circumference from those of higher BMI showed a reversal of the inverse association with mortality [23,24]. Higher muscle mass has also been shown to explain at least some of the positive effects attributed to elevated BMI [64,68]. However, there is also evidence to suggest that higher adiposity, especially subcutaneous (non-visceral) fat, may also be associated with better outcomes in ESRD patients [62].…”