Usefulness of computed tomography-measured psoas muscle thickness per height for predicting mortality in patients undergoing hemodialysis

Abstract

Computed tomography (CT)-measured psoas muscle thickness standardized for height (PMTH) has emerged as a promising predictor of mortality. The study aimed to investigate whether PMTH could accurately predict mortality in patients undergoing hemodialysis. We examined 207 patients (mean age: 63.1 years; men: 66.2%) undergoing hemodialysis for more than 6 months in hospital affiliated clinic. PMTH was calculated at the L3 vertebra level using CT. Patients were divided according to the PMTH cut-off points: 8.44 mm/m in women and 8.85 mm/m in men; thereafter, they were combined into low and high PMTH groups. PMTH was independently correlated with the simplified creatinine index (β = 0.213, P = 0.021) and geriatric nutritional risk index (β = 0.295, P < 0.0001) in multivariate regression analysis. During a median follow-up of 3.7 (1.8–6.4) years, 76 patients died, including 41 from cardiovascular causes. In the multivariate Cox regression analysis, low PMTH (adjusted hazard ratio, 2.48; 95% confidence interval, 1.36–4.70) was independently associated with an increased risk of all-cause mortality. The addition of binary PMTH groups to the baseline risk model tended to improve net reclassification improvement (0.460, p = 0.060). In conclusion, PMTH may be an indicator of protein energy wasting and a useful tool for predicting mortality in patients undergoing hemodialysis.

Psoas muscle index and psoas muscle density as predictors of mortality in patients undergoing hemodialysis

“…PMI was positively and independently associated with male sex and GNRI. Previous studies have reported that muscle mass volume differed with sex 6 , 14 , 17 , 18 ; in this study, the PMI was significantly higher in men than in women. In patients undergoing hemodialysis, PEW is highly prevalent and is associated with increased risks of morbidity and mortality 3 – 6 .…”

“…Previous studies have reported that muscle mass volume differed with sex 6 , 14 , 17 , 18 ; in this study, the PMI was significantly higher in men than in women. In patients undergoing hemodialysis, PEW is highly prevalent and is associated with increased risks of morbidity and mortality 3 – 6 . GNRI, which is easily calculable based on the serum albumin level and BMI, is a useful nutritional indicator to stratify the risk of PEW 22 – 26 ; therefore, our results suggest that PMI may be an indicator of PEW.…”

“…It may be caused by protein imbalance secondary to inflammation, increased protein catabolism, and insufficient calorie and protein intakes 2 . Protein energy wasting (PEW), a malnutrition state characterized by loss of muscle and fat mass due to chronic inflammation, is also highly prevalent among patients undergoing hemodialysis and is associated with an increased risk of mortality 3 – 6 . Thus, muscle wasting may partially explain PEW.…”

“…We have previously reported that the CT-measured psoas muscle thickness normalized by height, an easily available surrogate marker of muscle mass volume, may be an indicator of PEW and a promising predictor of mortality in patients undergoing hemodialysis 6 . The importance of evaluating both muscle quantity and quality using CT was recently proposed 11 – 13 .…”

Combined Evaluation of Geriatric Nutritional Risk Index and Modified Creatinine Index for Predicting Mortality in Patients on Hemodialysis

“…PEW, a malnutritional state defined by a loss of fat and muscle mass because of catabolic inflammation, is prevalent in patients receiving HD and is also related to increased risks of mortality [4,[21][22][23][24]. The MIS proposed by Kalanter-Zadeh et al is the gold standard method for assessing the nutritional status of HD patients [2].…”