Abstract
We compared the prognostic value of nutritional or volumetric parameters measured by body composition in hospitalized patients on maintenance hemodialysis. We conducted a cohort study to assess the association of different parameters of body composition with all-cause mortality in inpatients admitted to our nephrology department from January 2014 to December 2016. Of the 704 study patients, 160 (22.7%) died during a median follow-up of 33 months. In multivariate adjusted Cox models, higher ratio of extracellular water to body cell mass (ECW/BCM) (adjusted HR per 1-SD, 1.49; 95% CI, 1.19 to 1.85), lower lean tissue index (LTI) (adjusted HR per 1-SD, 0.70; 95% CI, 0.57 to 0.86) and lower body cell mass index (BCMI) (adjusted HR per 1-SD, 0.70; 95% CI, 0.58 to 0.85) were associated with a significantly greater risk of death. When these parameters were added to the fully adjusted model, BCMI performed best in improving the predictability for all-cause mortality (integrated discrimination improvement = 0.02, P = 0.04; net reclassification index = 0.11, P = 0.04). Among body composition indexes, ECW/BCM was the most relevant fluid volume indices to mortality and BCMI and LTI were the most relevant nutritional status indices to mortality in maintenance hemodialysis patients.
Highlights
Bioelectrical impedance analysis-based body composition analysis is widely used and accepted as an ideal tool for assessing fluid volume and nutritional status in maintenance dialysis patients[9]
We found that the extracellular water to body cell mass (ECW/BCM) of fluid volume indices and lean tissue index (LTI) and body cell mass index (BCMI) of nutritional status indices were most relevant to mortality
We calculated the cut-off values of ECW/BCM, LTI and BCMI in hemodialysis patients, which would be a reference for the intervention in fluid volume and nutritional status in future
Summary
Bioelectrical impedance analysis-based body composition analysis is widely used and accepted as an ideal tool for assessing fluid volume and nutritional status in maintenance dialysis patients[9]. It has both anthropometric parameters in assessing fluid volume [such as overhydration (OH)[10], OH/extracellular water (OH/ECW)[8,11,12,13,14], the ratio of extracellular water to intracellular water (ECW/ICW)[15], the ratio of extracellular water/body cell mass (ECW/BCM)16,17] and nutrition status [such as lean tissue index (LTI)[11,18,19,20,21,22,23], fat tissue index (FTI)[11,18], body cell mass index (BCMI)[24,25], BCM/weight26] It is still unclear which nutritional or volumetric parameters of body composition, measured by bioelectrical impedance, have the greatest prognostic value in maintenance hemodialysis patients. We designed this cohort study to assess and compare the association of different parameters in body composition with all-cause medium-term mortality in hemodialysis patients
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