Comparison of Body Mass Index, Skinfold Thickness, and Bioelectrical Impedance Analysis With Dual-Energy X-Ray Absorptiometry in Hemodialysis Patients.

Abstract

Malnutrition is a consistent finding in hemodialysis (HD) patients and is associated with high mortality. The aim was to compare nutrition status indicators using dual-energy x-ray absorptiometry (DXA) as reference in HD patients. Observational cross-sectional study with 42 patients, 55.8 years (±14.6) old, 60% male, HD 2-3 times per week for ≥3 months. HD ranged from 3 months to 28 years (median, 17.3; interquartile range, 8.73-39.0). We used body mass index (BMI) and fat mass (FM) by skinfold thickness (SFT), bioelectrical impedance analysis (BIA), and DXA. Statistical analyses used Bland-Altman plots, Lin's concordance correlation coefficient, the paired t-test, and Pearson or Spearman correlation. P < .05 was significant. SFT and DXA presented the lowest prevalence of malnutrition (2.4%) and BMI the highest (28.6%). BMI, BIA FM, and SFT FM presented strong positive correlations with DXA FM (r = 0.915; r = 0.976; r = 0.910, P < .001, respectively). BIA FM and fat-free mass (FFM) demonstrated substantial agreement with DXA values (ρ = 0.974 and 0.960, P < .001). Thus, the measurement procedures used, SFT and BIA, underestimated %FM (-4.65% and -2.13%) and overestimated FFM (3.12 kg and 1.0 kg) according to DXA. No differences were found between mean values of BIA FM and DXA (P = .178). Compared with DXA, BIA was the most appropriate nutrition indicator for measuring body composition.