The Diagnosis of Protein Energy Wasting in Chronic Peritoneal Dialysis Patients Is Influenced by the Method of Calculating Muscle Mass. A Prospective, Multicenter Study.

Cristina Techy Roth-Stefanski,Fabiana B Nerbass,Thyago Proença De Moraes,Naiane Rodrigues De Almeida,Gilson Biagini,Natália K Scatone

doi:10.3389/fmed.2021.702749

Abstract

Objective: To analyze the concordance and agreement between bioimpedance spectroscopy (BIS) and anthropometry for the diagnosis of protein energy wasting (PEW) in chronic peritoneal dialysis patients.Methods: Prospective, multi-center, observational study using multifrequency bioimpedance device (Body Composition Monitor -BCM®- Fresenius Medical Care) and anthropometry for the diagnosis of PEW as recommended by the International Society of Renal Nutrition and Metabolism (ISRNM). Cohen's kappa was the main test used to analyze concordance and a Bland-Altmann curve was built to evaluate the agreement between both methods.Results: We included 137 patients from three PD clinics. The mean age of the study population was 57.7 ± 14.9, 47.8% had diabetes, and 52.2% were male. We calculated the scores for PEW diagnosis at 3 and 6 months after the first collection (T3 and T6) and on average 40% of the study population were diagnosed with PEW. The concordance in the diagnosis of PEW was only moderate between anthropometry and BIS at both T3 and T6. The main factor responsible for our results was a low to moderate correlation for muscle mass in kilograms, with an r-squared (R2) of 0.35. The agreement was poor, with a difference of more than 10 kg of muscle mass on average and with more than a quarter of all cases beyond the limits of agreements.Conclusion: Current diagnosis of PEW may differ depending on the tools used to measure muscle mass in peritoneal dialysis patients.

Highlights

Protein energy wasting (PEW) is a common condition in patients with chronic kidney disease (CKD)
In peritoneal dialysis (PD), exposure to glucose as an osmotic agent may PEW Diagnosis in PD Patients lead to an absorption of up to 300 g glucose per day, depending on the patient’s membrane profile and the prescription of hypertonic solutions
The midarm muscle circumference (MAMC), was assessed by standard methods and classified according to percentile distribution tables adapted by Frisancho [12]. This is a prospective, multi-center, observational study designed to examine the concordance between bioimpedance spectroscopy (BIS) and anthropometry for the diagnosis of PEW

Summary

Introduction

Protein energy wasting (PEW) is a common condition in patients with chronic kidney disease (CKD). In peritoneal dialysis (PD), exposure to glucose as an osmotic agent may PEW Diagnosis in PD Patients lead to an absorption of up to 300 g glucose per day, depending on the patient’s membrane profile and the prescription of hypertonic solutions. Such glucose load has a direct impact on the patient’s appetite, reducing the daily intake of proteins and other nutrients [3, 4]. Patients have a daily loss of protein through the peritoneal membrane, which in some cases may reach 10 g, what can contribute to the deterioration of the nutritional status [5, 6]

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Results

Conclusion