Assessment of Nutritional Status by Dual-Energy X-Ray Absorptiometry in Chronic Kidney Disease Patients without Dialysis

Abstract

Objective: The objective was to evaluate the assessment of nutritional status by dual-energy X-ray absorptiometry (DEXA) in chronic kidney disease (CKD) patients not receiving dialysis. Patients and Methods: A total of 143 patients in stage 4-5 without receiving dialysis were enrolled and classified into well-nourished and malnourished groups by subjective global assessment. Biochemical and anthropometric measurements were performed. Simultaneously, body composition including lean body mass (LBM) and fat mass (FM) was evaluated by DEXA. Results: Compared with well-nourished patients, malnourished patients showed lower pre-albumin (ALB) levels, but higher C-reactive protein (CRP) levels. There was no significant difference in serum ALB between both groups. For either men or women, body weight, body mass index, and glomerular filtration rate (GFR) were lower in the malnourished group. For the men, triceps skin-fold thickness (TSFT), mid-arm circumference (AC), mid-arm muscle circumference (AMC), LBM-DEXA and FM-DEXA were significantly lower in the malnourished patients. For the women, TSFT, mid-AC and FM-DEXA, but mid-AMC and LBM-DEX, were not significantly lower in the malnourished patients. There was a significant correlation between LBM-DEXA and mid-AMC. A significant correlation also existed between FM-DEXA and TSFT. Multiple logistic regressions showed that low percentage of FM, high serum CRP level and low GFR were independent risk factors for malnutrition. Conclusions: Low percentage of FM, high serum CRP and low GFR are independent risk factors for malnutrition. Estimation of LBM and FM by dual X-ray absorptiometry is in consistent with traditional anthropometric measurements. It's noteworthy that DEXA, a reliable and easy-to-perform assessment method, can sensitively detect early malnutrition and may be useful in monitoring nutrition changes in CKD patients.