Relationship of bioelectrical impedance parameters to nutrition and survival in peritoneal dialysis patients

Mushnick, Robert; Fein, Paul A.; Mittman, Neal; Goel, Naveen Krishan; Chattopadhyay, Jyotiprakas; Avram, Morrell M.

doi:10.1046/j.1523-1755.64.s87.22.x

Cited by 132 publications

(99 citation statements)

References 18 publications

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“…A positive correlation between creatinine and PA has been previously reported 18,19 and supports the value of PA as a nutritional marker, particularly of muscle mass. Consistent with Mushnick et al 20 worse survival was also observed among our patients with PA < 6° according to univariate analysis.…”

Section: Discussionsupporting

confidence: 92%

Influence of protein intake and muscle mass on survival in chronic dialysis patients

et al. 2010

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Introduction: Some studies suggest that high body mass index (BMI) confers survival advantage in dialysis patients, but BMI does not differentiate muscle from fat mass, and the survival advantage conferred by its increase seems to be limited to patients with high muscle mass. Thus, discriminating body components when evaluating nutritional status and survival is highly important. This study evaluated the influence of nutritional parameters on survival in patients on chronic dialysis. Subjects and methods: Anthropometry, bioimpedance, biochemistry, and dietary recall were used to investigate the influence of nutritional parameters on survival in 79 prevalent patients on chronic dialysis. Results: Protein intake <1.2 g/kg/day and creatinine <9.7 mg/dL were independent predictors of mortality in all patients. Regarding dialysis method, protein intake <1.2 g/kg/day was predictive of mortality among hemodialysis patients, and percent standard mid-arm muscle circumference <80% was identified as a risk factor among peritoneal dialysis patients. Conclusion: Higher muscle mass, possibly favored by a higher protein intake, conferred survival advantage in dialysis patients.

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Section: Discussionsupporting

confidence: 92%

Influence of protein intake and muscle mass on survival in chronic dialysis patients

et al. 2010

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“…[10][11][12] Moreover, phase angle appears to reflect prognosis in populations with chronic disease. [13][14][15][16][17][18] Whether phase angle is associated with frailty and mortality in the general population is unknown.…”

Section: Introductionmentioning

confidence: 99%

Phase Angle, Frailty and Mortality in Older Adults

Wilhelm-Leen

Hall²,

Horwitz

et al. 2013

J GEN INTERN MED

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BACKGROUND: Frailty is a multidimensional phenotype that describes declining physical function and a vulnerability to adverse outcomes in the setting of physical stress such as illness or hospitalization. Phase angle is a composite measure of tissue resistance and reactance measured via bioelectrical impedance analysis (BIA). Whether phase angle is associated with frailty and mortality in the general population is unknown. OBJECTIVE: To evaluate associations among phase angle, frailty and mortality. DESIGN: Population-based survey. SETTING: Third National Health and Nutritional Examination Survey (1988)(1989)(1990)(1991)(1992)(1993)(1994). PARTICIPANTS: In all, 4,667 persons aged 60 and older. MEASUREMENTS: Frailty was defined according to a set of criteria derived from a definition previously described and validated. RESULTS: Narrow phase angle (the lowest quintile) was associated with a four-fold higher odds of frailty among women and a three-fold higher odds of frailty among men, adjusted for age, sex, race-ethnicity and comorbidity. Over a 12-year follow-up period, the adjusted relative hazard for mortality associated with narrow phase angle was 2.4 (95 % confidence interval [95 % CI] 1.8 to 3.1) in women and 2.2 (95 % CI 1.7 to 2.9) in men. Narrow phase angle was significantly associated with mortality even among participants with little or no comorbidity. LIMITATIONS: Analyses of BIA and frailty were crosssectional; BIA was not measured serially and incident frailty during follow-up was not assessed. Participants examined at home were excluded from analysis because they did not undergo BIA. CONCLUSIONS: Narrow phase angle is associated with frailty and mortality independent of age and comorbidity.

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“…Phase angle has been shown to be predictive of survival in dialysis population [21]. We have demonstrated that newer normalized bioimpedance parameters have better survival predictive value compared to phase angle [10].…”

Section: Discussionmentioning

confidence: 78%

Ratio of Capacitance/BMI Reflects Deficit in Nutritional Concentration While CH2 Reflects Total Nutritional Deficit in CAPD Patients and General Population

Koh¹,

Wong²

2013

OJNeph

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Traditionally phase angle was the best predictor in BIA for nutrition and survival in dialysis population. We recently showed that normalized bioimpedance indices are a better risk discriminator for dialysis patients and the general population. We hereby aimed to explore discriminating factors behind them. Methods: We assessed the body capacitive index (BCI = Capacitance × Height ) which represents total body capacitive volume in physics. We initially performed BIA for 206 female, 116 male healthy volunteers, followed by, prospective study for 128 CAPD patients (47 diabetes mellitus (DM), 81 non-DM; 59 male, 69 female) for >2 years. Results: Moderately good negative correlation of albumin and BCI (r = −0.533, p < 0.001) with linear regression (BCI = 8.780 − 0.184 × [albumin], R 2 = 0.339, p < 0.001) was shown in CAPD patients. BCI and CH 2 were much higher in CAPD patients in comparison to healthy volunteers (3.4 ± 0.1 vs 2.0 ± 0.0 nFm 2 /kg, p < 0.001 and 203 ± 8 vs 125 ± 1 nFm 2 , p < 0.001, respectively). In age and gender adjusted logistic regression model of 128 CAPD patients versus 322 healthy volunteers, the best risk discriminator was BCI (X 2 = 165.6), followed by CH 2 (X 2 = 140), phase angle (X 2 = 59.3) and BRI (X 2 = 52.2). Thirty five (27.3%) patients died during the study period (Fatal cause: infection (54%), cardiovascular (26%)). In Cox regression, CH 2 ( 2 4 X = 32.4) was the best predictor for all-cause mortality, followed by BCI ( 2 4 X = 27.7) and phase angle ( 2 4 X = 19.3). Conclusion: The phase angle was a compound parameter of the body capacity index (BCI) and body resistive index (BRI). BCI has a moderately good negative correlation with albumin and this supports its role in reflecting the severity of malnutrition in CAPD patients. CH 2 represents total nutrition deficit and thus the major risk indicator for the survival of CAPD patients.

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Relationship of bioelectrical impedance parameters to nutrition and survival in peritoneal dialysis patients

Cited by 132 publications

References 18 publications

Influence of protein intake and muscle mass on survival in chronic dialysis patients

Influence of protein intake and muscle mass on survival in chronic dialysis patients

Phase Angle, Frailty and Mortality in Older Adults

Ratio of Capacitance/BMI Reflects Deficit in Nutritional Concentration While CH2 Reflects Total Nutritional Deficit in CAPD Patients and General Population

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