Low Lean Tissue Index Research Articles

Association of changes in body composition with all-cause mortality in patients undergoing hemodialysis: A prospective cohort study

ObjectivesThis study aimed to explore the effect of longitudinal body composition changes on mortality risk in patients undergoing hemodialysis and identify whether changes in body composition can more accurately predict mortality than baseline status. MethodsA prospective cohort study was conducted on 340 patients undergoing hemodialysis. Lean mass and body fat were determined using a bioimpedance spectroscopy (BIS) device and expressed as the lean tissue index (LTI) or fat tissue index (FTI), respectively. The patients were subjected to BIS at baseline and after 1 year. The hazard ratio (HR) for death was calculated using Cox regression analysis. ResultsAmong 340 patients, 289 were tested with a repeat BIS. LTI loss and FTI gain were observed in 51.2% and 47.1% of the patients, respectively. Low baseline LTI was a significant predictor of all-cause mortality after adjusting for demographic and biochemical parameters (HR, 2.41; P = 0.047), but not when comorbidities were included in the multivariate analysis. However, after adjusting for various confounding factors, LTI loss (HR, 3.40; P = 0.039) and FTI gain (HR, 4.06; P = 0.024) were independent risk factors for all-cause mortality, and the adjusted HR for LTI loss and FTI gain vs. no LTI loss and no FTI gain was 5.34 (P = 0.016). ConclusionsLTI loss and FTI gain, particularly their combination, are important predictors of survival in patients undergoing hemodialysis. Our results emphasize that longitudinal changes in LTI and FTI are more strongly associated with all-cause mortality than single-point values. Therefore, it is important to dynamically assess the muscle and fat tissues and develop potential targeted treatment strategies for this population.

Impact of Fat Mass on Osteoporosis, Sarcopenia, and Osteosarcopenia in Peritoneal Dialysis Patients

Introduction: The relationship between fat mass and osteoporosis, sarcopenia, and osteosarcopenia is complex. While higher fat mass generally has a negative impact on bone and muscle health in the general population, the impact in peritoneal dialysis (PD) patients is less well understood. Methods: In this study of 359 PD patients, sarcopenia was identified using appendicular skeletal muscle per square meter (ASM/m2), with cut-off values of <7.0 kg/m2 for men and <5.5 kg/m2 for women. Fat tissue index (FTI) and lean tissue index (LTI) were determined using body composition monitoring, with the lowest tertile classified as low FTI and low LTI. Bone mineral density was measured, with a T-score below −2.5 indicating osteoporosis. Results: The prevalence of osteoporosis, sarcopenia, and osteosarcopenia was 25%, 32%, and 15%, respectively. Notably, 60% of osteoporotic patients had sarcopenia, and about 45% of sarcopenic patients had osteoporosis. Patients with osteoporosis were older and had significantly lower LTI (15.3 vs. 12.7 kg/m2, p < 0.001) and ASM (7.3 vs. 5.8 kg/m2, p < 0.001). Osteoporotic patients also had lower FTI, but this was more pronounced in men than in women. Patients with both sarcopenia and osteoporosis had the lowest LTI and FTI compared to those with only one or neither condition. Low FTI was a significant determinant for osteoporosis (OR, 2.34; 95% CI, 1.43–3.85; p = 0.001), sarcopenia (OR, 2.91; 95% CI, 1.82–4.64; p < 0.001), and osteosarcopenia (OR, 2.34; 95% CI, 1.30–4.24; p = 0.005) in univariate analysis, and these associations remained significant after adjustment for age and body mass index. Conclusion: Osteoporosis and sarcopenia are common and interrelated in PD patients. Low fat mass, but not normal/high fat mass, was significantly associated with these conditions, suggesting the importance of maintaining adequate fat mass in PD patients.

Sarcopenia diagnosed by ultrasound-assessed quadriceps muscle thickness and handgrip strength predicts mortality in patients on hemodialysis.

Estimation of muscle mass is a pivotal component in the diagnosis of protein-energy wasting and sarcopenia. While bioimpedance spectroscopy is a widely accepted technique for the assessment of lean tissue related to the diagnosis of sarcopenia, to date skeletal muscle ultrasound (US) has not gained full acceptance for this purpose. The aim of this study was to assess the predictive value for mortality of the indexed thickness of the quadriceps vastus intermedius, as measured by US, compared to lean tissue index as estimated by bioimpedance spectroscopy, both combined with handgrip strength in a group of patients with end-stage kidney disease (ESKD) on maintenance hemodialysis (HD). The cut-off values for low handgrip strength were < 27kg for males and < 16kg for females. The cut-off value for low lean tissue index was obtained from an age-matched healthy control group, with low lean tissue index being defined as values below the 10th percentile of the distribution of healthy subjects. The cut-off values for low quadriceps vastus intermedius thickness index were < 3.44mm/m2 for males and < 3.52mm/m2 for females. Ultrasound and bioimpedance spectroscopy were performed in 99 patients, and handgrip strength was assessed in 64 patients, all on maintenance HD. After a median follow-up of 28months (interquartile range 19-41months) 38 patients died. Lean tissue index was not associated with mortality, while low quadriceps vastus intermedius thickness index and low handgrip strength were associated with an increased hazard of death. In the fully adjusted model, only the combination of low handgrip strength and low quadriceps vastus intermedius thickness index was significantly associated with higher mortality. When combined with low handgrip strength, low quadriceps muscle US outperformed low lean tissue index as assessed by bioimpedance spectroscopy in predicting mortality in a cohort of patients on maintenance HD. Ultrasound may be a useful and convenient technique for the assessment of sarcopenia and protein-energy wasting in this patient population.

The value of bioimpedance analysis in the assessment of hydration and nutritional status in children on chronic peritoneal dialysis

Bioimpedance analysis (BIA)–body composition monitoring (BCM) has been used to evaluate the hydration and nutritional status of adults and children on dialysis. However, its clinical application still has challenges, so further exploration is valuable. We used BIA-BCM to evaluate the hydration and nutritional status of children undergoing chronic peritoneal dialysis from 1 July 2021 to 31 December 2022 in the Children’s Hospital of Fudan University to explore the clinical value of this method. A total of 84 children on chronic peritoneal dialysis (PD) were included. In the PD group, 16 (19.05%) and 31 (36.90%) had mild and severe overhydration (OH), respectively; 41.27% (26/63) had a low lean tissue index (LTI). In the PD group, patients with relative OH (Re-OH) > 5.6% had significantly higher systolic blood pressure (SBP) and SBP z score (SBPz). Patients with LTI > 12% had significantly higher body mass index (BMI) and BMI z score (BMIz). Canonical correlation analysis indicated a linear relationship (ρ = 0.708) between BIA-BCM hydration and the clinical hydration indicator and a linear relationship (ρ = 0.995) between the BIA-BCM nutritional indicator and the clinical nutritional indicator. A total of 56% of children on chronic peritoneal dialysis had OH, and 41% had a low LTI. In PD patients, SBP and SBPz were correlated with BIA-BCM Re-OH, and BMI and BMIz were correlated with BIA-BCM LTI. BIA-BCM indicators have good clinical value in evaluating hydration and nutrition.

Elevated Ferritin Levels Associated with High Body Fat Mass Affect Mortality in Peritoneal Dialysis Patients.

Obesity is a common health problem in peritoneal dialysis (PD) patients and causes high serum ferritin levels. However, mixed results have been reported on whether serum ferritin levels affect the prognosis of PD patients. We investigated the effect of increased adiposity on ferritin levels and its association with mortality in 350 well-nourished PD patients. Body composition was measured using a portable whole-body bioimpedance spectroscope, and clinical determinants of high ferritin levels were evaluated. High ferritin levels (≥600 ng/mL) were observed in 63 (18.0%) patients. Patients with high ferritin levels had a significantly higher body fat percentage and a lower lean tissue index than patients with low or normal ferritin levels. During a median follow-up of 30 months, there were 65 deaths. Ferritin ≥ 600 ng/mL was associated with significantly higher all-cause mortality compared with 200-600 ng/mL of ferritin. Multivariate analysis showed that high ferritin levels were significantly associated with a higher percentage of body fat after adjustment for lean tissue index and volume status. High ferritin increased all-cause mortality in PD patients, and increased fat mass was an important determinant of the high ferritin. Our results support that adiposity may lead to an adverse clinical outcome in PD patients.

Low Lean Tissue Index and Muscle Strength Combined with High Fat Tissue Index Are Associated with Cardiovascular Disease-Related Hospitalisation in Patients on Haemodialysis

Introduction: The combined clinical impact of muscle mass, muscle function, and adipose mass on hospitalisation events, especially those that have exact causes, such as cardiovascular diseases (CVDs), had been rarely studied in patients on haemodialysis (HD). This study aimed to determine the influence of lean tissue index (LTI), fat tissue index (FTI), and hand grip strength (HGS) on the risk of CVD-related hospitalisation in patients undergoing chronic HD. Methods: This multi-centre observational study enrolled a total of 2,041 clinically stable patients aged >18 years and who had undergone HD for at least 3 months at 17 HD units in 2019. The follow-up period was up to 2 years. LTI and FTI were assessed using a body composition monitoring machine, and HGS was measured by a CAMRY® dynamometer. Cox regression models were fit to estimate the associations of body composition and HGS with CVD-related hospitalisation risk. Results: During a mean follow-up of 22.6 months, CVD-related hospitalisation occurred in 492 patients. Compared with the non-CVD group, patients with CVD-related hospitalisation were older; had lower diastolic blood pressure; were more likely to have a history of diabetes; had worse activity status scores and lower levels of LTI, HGS, serum uric acid, and serum creatinine; and had higher FTI levels, body mass index, and extracellular water/intracellular water ratio. In the Cox regression models, low LTI and high FTI were independently associated with CVD-related hospitalisation in both men and women. In men, low HGS was an independent risk factor for CVD-related hospitalisation. When patients were further stratified into four distinct groups according to the sex-specific median values of LTI and FTI, the combination of low LTI and high FTI was an independent risk factor for CVD-related hospitalization (hazard ratio [HR] = 1.79 in men, 95% confidence interval 1.26–2.55; HR = 2.48 in women, 95% confidence interval 1.66–3.71; reference: high LTI/low FTI group). Conclusions: Among patients on chronic HD, low LTI, and high FTI were associated with CVD-related hospitalisation in men and women, whereas HGS was an independent risk factor for CVD-related hospitalisation in men but not in women. Combining low LTI and high FTI increased the association with hospitalisation risk and was an independent predictor of CVD-related hospitalisation.

Established risk prediction models for the incidence of a low lean tissue index in patients with peritoneal dialysis

Objective The objective of this study is to investigate the incidence of low lean tissue index (LTI) and the risk factors for low LTI in peritoneal dialysis (PD) patients, including to establish risk prediction models. Methods A total of 104 PD patients were enrolled from October 2019 to 2021. LTI was measured by bioimpedance spectroscopy. Multivariate logistic regression and machine learning were used to analyze the risk factors for low LTI in PD patients. Kaplan–Meier analysis was used to analyze the survival rate of patients with low LTI. Results The interleukin-6 (IL-6) level, red cell distribution width (RDW), overhydration, body mass index (BMI), and the subjective global assessment (SGA) rating significantly differed between the low LTI and normal LTI groups (all p < 0.05). Multivariate logistic regression showed that IL-6 (1.10 [95% CI: 1.02–1.18]), RDW (1.87 [95% CI: 1.18–2.97]), BMI (0.97 [95% CI: 0.68–0.91]), and the SGA rating (6.33 [95% CI: 1.59–25.30]) were independent risk factors for LTI. Cox regression analysis showed that low LTI (HR 3.14, [95% CI: 1.12–8.80]) was the only significant risk factor for all-cause death in peritoneal dialysis patients. The decision process to predict the incidence of low LTI in PD patients was established by machine learning, and the area under the curve of internal validation was 0.6349. Conclusions Low LTI is closely related to mortality in PD patients. Microinflammatory status, high RDW, low BMI and low SGA rating are risk factors for low LTI in PD patients. The developed prediction model may serve as a useful tool for assessing low LTI in PD patients.

Serum cystatin C to creatinine ratio is associated with sarcopenia in non-dialysis-dependent chronic kidney disease.

BackgroundSarcopenia is a prevalent complication in patients with chronic kidney disease and is associated with poor quality of life, morbidity, and mortality. Several candidate biomarkers have been evaluated for this condition. This study assessed the serum cystatin C to creatinine (serum cystatin C/Cr) ratio as a potential biomarker for sarcopenia in patients with non-dialysis-dependent chronic kidney disease.MethodsThis study enrolled 517 outpatients. Muscle mass (lean tissue index) was measured using a bioimpedance spectroscopic device, and muscle strength (handgrip strength) was also measured. Sarcopenia was defined as a combination of low muscle strength and low muscle mass.ResultsSarcopenia was observed in 25.5% of patients, and the mean serum cystatin C/Cr ratio was significantly higher in patients with sarcopenia than in those without it (1.14 ± 0.26 vs. 1.01 ± 0.27, p < 0.001). The prevalence of sarcopenia and low lean tissue index increased as the cystatin C/Cr ratio increased. The negative predictive value of the cystatin C/Cr ratio for sarcopenia or low lean tissue index was ≥80%. Multivariate analyses revealed that when the serum cystatin C/Cr ratio increased by 1, the risk of sarcopenia, low lean tissue index, and low handgrip strength increased by 4.6-, 7.2-, and 2.6-fold, respectively (p = 0.003, p < 0.001, and p = 0.048). The association was maximized in patients with an estimated glomerular filtration rate of <30 mL/min/1.73 m2.ConclusionCalculating the serum cystatin C/Cr ratio could be helpful for detecting and managing sarcopenia in patients with chronic kidney disease.

Anemia, overhydration, and lower muscle strength in hemodialysis patients with protein-energy wasting.

The protein-energy wasting (PEW) syndrome is a common complication in hemodialysis (HD) patients associated to morbidity and mortality. Our objective was to assess the prevalence of PEW and its association with erythropoietin resistance index (ERI) score, body composition by impedance, health-related quality of life, and muscle strength. In this cross-sectional, observational, multicenter study, we included data from 191 HD patients from three HD clinics located in Mexico City, Mexico. Clinical and biochemistry variables, body composition, handgrip strength, and the KDQOL-SF36 questionnaire were collected for each patient. Prevalence of PEW was 22% (n=41/191), with a higher frequency in those with diabetes mellitus (59% vs. 49%, p=0.04). Subjects with PEW had lower hemoglobin levels (9.5 + 1.6g/dl vs. 10.3 + 1.7g/dl; p=0.005) and higher ERI scores (19.2 ± 11.2 vs. 15.6 ± 8.2; p=0.04) compared with the non-PEW group. In analysis of body composition, PEW was associated to higher overhydration status (42.2 vs. 24.9 OH/kg; p=0.009), higher extracellular water (263 ± 40 vs. 246 ± 32 ml/kg; p =0.019), lower lean tissue index (12.2 ± 3.2 vs. 14.1 ± 3.7ml/m2 ; p=0.021), and lower fat tissue index (9.6 ± 5.7 vs. 12.3 ± 6.2ml/m2 ; p=0.043). Handgrip strength was lower in PEW patients (22.5 vs. 28.1kg; p=0.002). Finally, no significant differences were observed between groups in quality-of-life assessment. In this study, PEW was associated to poor responsiveness to erythropoiesis-stimulating agents, lower muscle strength, and higher overhydration status due to the increase in extracellular water which replaced the loss of tissue. Nevertheless, quality-of-life assessment was not different in patients with PEW compared with those without this complication.

MO671: Should We Undergo Peritoneal Dialysis in Malnourished Chronic Kidney Disease Patients?

Abstract BACKGROUND AND AIMS The implementation of peritoneal dialysis (PD) in end-stage renal disease has been associated with various long-term pathophysiologic changes, which result in adverse consequences, such as malnutrition, occurring in 30–50% of patients. Specific factors to PD might be associated with poor oral intake as continuous absorption of glucose from PD solutions and abdominal fullness induced by the dialysate can suppress appetite. There are several accepted strategies for stratifying malnutrition in PD, such as laboratory markers [serum albumin and normalized protein catabolic ratio (nPCR)] and the recent use of bioimpedance spectroscopy (BIS) (with low lean tissue index). We aimed to evaluate if PD patients with a poor nutritional status at the beginning of the technique had worse outcomes (peritonitis, PD failure, hospitalizations, and death). METHOD We studied a cohort of incident patients from a single PD unit between 1 July 2011 and 31 August 2021, who had one BIS measurement and a peritoneal equilibration test in the first 3 months after the start of PD. We also collect laboratory data within 6 months from the BIS evaluation (serum albumin). Besides demographic parameters, we evaluated established endpoints (peritonitis, PD failure, hospitalizations and death). RESULTS There were included 91 PD patients. The mean age of patients was 65.40 $ \pm $ 13.88 years with a median dialysis vintage of 24 (IQR 14–31.61) months; 59.3% were male and 28% had diabetes. During the follow-up period, 5.5% of the cohort died, 56% were hospitalized and 47.3% had at least one episode of peritonitis. Furthermore, the transfer to hemodialysis occurred in 18 cases (19.8%) and 15 (16.5%) received a renal transplant. There was no difference in nutritional markers median in patients that had clinical endpoints versus those who had not (Table 1). In a multivariable analysis, neither nPCR, nor albumin nor lean tissue index were predictors of peritonitis, PD failure or hospital admissions. CONCLUSION In this study, we found that malnourished patients, prevalent in PD, did not have worse clinical endpoints (higher rate of infections, hospital admissions and PD failure). Although adequate nutrition has been deemed vital to the success of PD, this modality of renal replacement therapy did not result in worse outcomes, despite the malnutrition markers at the beginning of PD. Further studies are warranted to evaluate the positive impact of PD in nutrition status.

MO689: Relationship between Peritoneal/Renal Function and Nutritional Status in Peritoneal Dialysis Patients

Abstract BACKGROUND AND AIMS The positive impact of nutritional status on the health and treatment adequacy of peritoneal dialysis (PD) patients has been well established. There are several accepted strategies for stratifying malnutrition in PD, such as laboratory markers [serum albumin and normalized protein catabolic ratio (nPCR)] and the recent use of bioimpedance spectroscopy (BIS). The aim of this study was to assess the nutritional status of PD patients upon the start of the therapy. We also aimed to establish a potential relationship between peritoneal/renal function, obtained by a peritoneal equilibration test (PET), and nutritional markers. METHOD We studied a cohort of patients from a single PD unit between 1 July 2011 and 31 August 2021, who had one BIS measurement and a PET in the first 3 months after the beginning of PD. We also collect laboratory data within 6 months from the BIS reading (albumin, C-reactive protein and phosphorus). Demographic parameters (age, dialysis vintage, presence or absence of diabetes mellitus) and body mass index were also evaluated. RESULTS The study included 91 incident PD patients. The mean age of patients was 65.40 $ \pm $ 13.88 years, 59.3% were male and 28% had diabetes. Regarding baseline renal and peritoneal parameters, weekly total kt/v median was 1.99 (IQR 0.99–2.59) residual renal function (eGFR) median 3.2 (IQR 2.12–7.75) mL/min/1.73 m2 daily diuresis median 1500 (IQR 1000–2100), fluid removal (FR) median 2.23 (IQR 1.86–2.65) L/day and 41.8% had a dialysate/plasma (D/P) creatinine higher than 0.77. Lean tissue index was low in 36.3% and fat tissue index was high in 52.2%. Serum albumin median was 3.7 (IQR 3.3–4) g/dL and nPCR median 0.84 (IQR 0.72–1.04) g/kg/day. Hypervolemic patients had significantly lower lean tissue index (13.77 ± 3.25 versus 16.87 ± 3.82, P = 0.003). In a univariate analysis, patients with nPCR &amp;lt; 1.2 g/kg/day (79.1% from the complete cohort with no age difference) had lower baseline weekly total kt/v (2.17 ± 0.43 versus 6.62 ± 4.45, P &amp;lt; 0.001, lower daily diuresis (1261 ± 753 versus 1687 ± 958, P = 0.047), lower FR (2.05 ± 0.57 versus 2.40 ± 0.80, P = 0.043), and also significantly lower D/P creatinine (0.74 ± 0.1 versus 0.97 ± 0.27, P &amp;lt; 0.001). Furthermore, patients with serum albumin &amp;lt;3.8 g/dL had a lower ultrafiltration proof (326 ± 192 versus 511 ± 267, P = 0.028) and those with low lean tissue index had a lower daily diuresis (1405 ± 825 versus 1823 ± 1025, P = 0.045). In a multivariate analysis, patients with nPCR &amp;lt; 1.2 g/kg/day were older [exp (B) 0.19, 95% CI 0.8–0.9, P = 0.012] and had lower weekly total kt/v [exp (B) 0.18, 95% CI 0.6–0.9, P = 0.017]. CONCLUSION This study showed some relationships between kidney/peritoneal function parameters and body composition parameters. The level of nPCR, a measure of nutritional status, was significantly and positively associated with indicators of dialysis adequacy (kt/v), daily diuresis and, also with transport type. Further research regarding nutrition must be undertaken to help improve health outcomes in PD patients.

Association of Prescription With Body Composition and Patient Outcomes in Incident Peritoneal Dialysis Patients.

Objective: The nutritional status of patients on peritoneal dialysis (PD) is influenced by patient- and disease-related factors and lifestyle. This analysis evaluated the association of PD prescription with body composition and patient outcomes in the prospective incident Initiative for Patient Outcomes in Dialysis–Peritoneal Dialysis (IPOD-PD) patient cohort.Design and Methods: In this observational, international cohort study with longitudinal follow-up of 1,054 incident PD patients, the association of PD prescription with body composition was analyzed by using the linear mixed models, and the association of body composition with death and change to hemodialysis (HD) by means of a competing risk analysis combined with a spline analysis. Body composition was regularly assessed with the body composition monitor, a device applying bioimpedance spectroscopy.Results: Age, time on PD, and the use of hypertonic and polyglucose solutions were significantly associated with a decrease in lean tissue index (LTI) and an increase in fat tissue index (FTI) over time. Competing risk analysis revealed a U-shaped association of body mass index (BMI) with the subdistributional hazard ratio (HR) for risk of death. High LTI was associated with a lower subdistributional HR, whereas low LTI was associated with an increased subdistributional HR when compared with the median LTI as a reference. High FTI was associated with a higher subdistributional HR when compared with the median as a reference. Subdistributional HR for risk of change to HD was not associated with any of the body composition parameters. The use of polyglucose or hypertonic PD solutions was predictive of an increased probability of change to HD, and the use of biocompatible solutions was predictive of a decreased probability of change to HD.Conclusion: Body composition is associated with non-modifiable patient-specific and modifiable treatment-related factors. The association between lean tissue and fat tissue mass and death and change to HD in patients on PD suggests developing interventions and patient counseling to improve nutritional markers and, ultimately, patient outcomes.Study Registration: The study has been registered at Clinicaltrials.gov (NCT01285726).

Body Composition of Chronic Kidney Disease Patients

With accelerated muscle proteolysis, a decrease in muscle mass is evident in chronic kidney disease (CKD) patients. This eventually leads to nutritional disturbance that for a long has been mostly attributed to malnutrition. This predisposes patients to premature morbidity and mortality. Assessing body composition, thus, becomes vital. In this cross-sectional study, CKD patients (n = 47) of stages 2, 3a, 3b and 4 were assessed for their lean tissue mass, adipose tissue mass and overhydration by body composition monitor. Lean tissue index and fat tissue index were calculated as lean tissue mass and adipose tissue mass in kilogram divided by patients’ height in square meters. Patients were assessed for their handgrip strength (HGS) by Jamar hydraulic hand dynamometer, and also for their 7-day diet history. Mean lean tissue index of CKD patients was 11.73 ± 2.49 kg/m2. About 34 (72.3%) out of 47 patients were below the reference value of lean tissue index. A significant difference in lean tissue index (P = 0.03) was observed at various stages. Patients at stage 4 had the lowest lean tissue index. Lean tissue was significantly (P = 0.03) low in patients consuming protein &lt;0.6 gm/kg/day. All 47 patients had less than normal HGS values. Patients’ mean fat tissue index was 14.86 ± 6.18 kg/m2 and had water retention with a mean overhydration of 1.47 ± 2.12 L. CKD patients were malnourished with a significant low lean tissue index. Dietary protein intake and HGS of these patients were positively associated with lean tissue index.

MO790PREDICTORS OF ERYTHROPOIETIN HIPORESPONSIVENESS IN PREVALENT PATIENTS ON PERITONEAL DIALYSIS: A CROSS-SECTIONAL STUDY

Abstract Background and Aims Anemia resistant to recombinant human erythropoietin (EPO) is a risk factor for mortality in dialyzed patients with chronic kidney disease. Identifying the causes of hyporesponsiveness may help overcome this resistance. The aim of this study was to investigate the risk factors of EPO hyporesponsiveness in a prevalent population of patients on peritoneal dialysis (PD). Method Cross-sectional study involving 50 prevalent DP patients. To evaluate the dose–response effect of EPO therapy, we used the erythropoietin resistance index (ERI), calculated as the average weekly weight-adjusted dose of EPO (U/Kg per week) divided by the average hemoglobin level (g/dL), over a 3-month period. Patients were classified in two groups according to ERI: ERI ≤ 10 and ERI &amp;gt; 10. We compared clinical, analytical and demographic data among groups. Body composition and fluid volume were evaluated by bioimpedance using the body composition monitor (BCM). Logist regression analysis was performed to identify predictors of EPO hyporesponsiveness. Statistical analysis was executed using SPSS (Version 23 for Mac OSX). Results The average age of 50 prevalent DP patients was 52.04 ± 15.98 years, 29 (58%) were male, 29 (58%) were diabetic and 31 (64%) were treated with angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB). Average hemoglobin level (Hb) was 10.99 ± 0.81g/dL and average ERI was 7.64 ± 7.25. Eleven patients (22%) had hyporesponsiveness to EPO therapy (ERI&amp;gt;10). There was no age, gender, cause of chronic kidney disease or PD modality difference among groups. There was also no difference in the use of ACEIs or ARBs. Hyporesponsive patients had lower body mass index (BMI) (22.94 ± 2.89 vs 26.74 ± 4.53Kg/m2, p=0.01) and lower lean tissue index (LTI) (9.96 ± 1.94 vs 16.23 ± 18.51Kg/m2, p=0.02), but not fat tissue index (FTI). Weekly creatinine clearance (peritoneal plus urinary), but not Kt/V, was also significantly lower in this group (68.76 ± 37.29 vs 87.84 ± 35.35L/1.73m2, p=0.028). Hyporesponsive patients had lower urine volume (0.73 ± 0.63 vs 1.39 ± 0.67L, p=0.005) and residual kidney function (3.43 ± 3.04 vs 6.13 ± 3.69mL/min/1.73m2, p=0.044). The proportion of patients with fluid overload, defined as overhydration (OH)/extracellular water (ECW) &amp;gt; 15%, was significantly higher in this group (p=0.04). No difference was observed in albumin, c-reactive protein, serum iron, serum ferritin, transferrin saturation index or parathormone among groups. In a logist regression analysis, BMI [(OR) 0.56 (CI: 0.364-0.849)] and LTI [(OR) 0.315 (CI: 0.130-0.767)] were predictors of hyporesponsiveness to EPO therapy. Conclusion Lower BMI and lower LTI were predictors of resistance to EPO therapy in our study. Body composition, fluid status and residual kidney function seem to be the main factors influencing the response to EPO therapy in prevalent patients on PD, emphasizing the importance of strategies oriented to preserve residual kidney function in these patients.

MO910CHANGE IN BODY COMPOSITION MEASURED BY BIOIMPEDANCE SPECTROSCOPY AFTER COVID19 LOCKDOWN IN HAEMODIALYSIS PATIENTS

Background and AimsChanges on body composition have an impact on the survival of haemodialysis (HD) patients. The aim of the study was to determine the impact of the reduction of physical activity due to COVID19 lockdown on body composition in HD patients.MethodRetrospective and observational study including 149 HD patients. Nutritional and Bioimpedance spectroscopy (BIS) data were recorded before and after COVID19 lockdown (mean of 148 ± 20 days between determinations).ResultsOver the 49 days of COVID19 lockdown, we observed a decrease in normohydrated weight (NHW) of 1.01 ± 3.59 kg mainly secondary to a reduction on total body water (TBW) 0.95 ± 3.78 L (extracellular water 0.45 ± 1.58 L and intracellular water 0.41 ± 2.36 L). There was also a small loss on lean tissue index (LTI) of 0.28 ± 2.42 kg/m2, with an increase of fat tissue index (FTI) 0f 0.02 ± 2.82 kg/m2. Twenty-three patients presented COVID19 infection, of which 21 required admission (median of 10 [4-16] days). Patients who presented COVID19 were older (70.7 ± 12.0 vs 64.9 ± 16.6 years, NS) with higher Charlson index (7.48 ± 2.77 vs 6.33 ± 2.65, p = 0.07). Patients with COVID19 infection presented a greater loss on LTI (-1.18 ± 3.15 bs -0.16 ± 2.30 kg/m2; p = 0.22), FTI (-0.41 ± 3.38 vs 0.06 ± 2.74 kg/m2; p = 0.54); BMI (-1.49 ± 2.14 vs -0.25 ± 0.96 kg/m2; p = < 0.01) and NHW (-4.00 ± 6.33 vs -0.62 ± 2.90 kg; p = < 0.01) compared to patients without COVID19 infection. The length of hospitalization was associated with greater loss of BMI and NHW, resulting, therefore, in overhydration. There also had lower serum phosphorus (3.6 ± 0.8 vs 5.2 ± 0.8 mg/dl; p = 0.01) and serum albumin (3.5 ± 0.4 vs 4.0 ± 0.1 g/dl; p = 0.01). Seven patients died during hospitalization. Deceased patients were older (78.4 ± 6.6 vs 67.4 ± 12.4 years; p = 0.01), presented higher comorbidity (estimated by Charlson index 10.0 [8.0-11.0] vs 6.5 [4.3-8.0]; p = 0.02) and were more overhydrated (3.4 ± 3.6 vs 1.9 ± 1.9; p = 0.34). Although not statistically different, they had lower LTI (10.4 ± 2.1 vs 12.0 ± 3.4 kg/m2; p = 0.18) and lower serum albumin (3.4 ± 0.6 vs 3.9 ± 0.4 g/dl; p = 0.08) compared to survivors. Patients who survived COVID19 infection had longer hospitalization (57% were discharged between twelfth and forty third day; mean hospitalization 14.6 ± 11.5 days). Deceased patients died within the first 12 days of hospitalization (6.8 ± 4.1 days).ConclusionCOVID19 lockdown induced a weight reduction on HD patients due to decrease in total body water. COVID19 infection increased this reduction, inducing greater loss on lean and fat tissue composition. Moreover, COVID19 impact on body composition was magnified with the length of hospitalization.

Circulating fatty acid profiles are associated with protein energy wasting in maintenance hemodialysis patients: a cross-sectional study

The metabolic impact of circulating fatty acids (FAs) in patients requiring hemodialysis (HD) is unknown. We investigated the associations between plasma triglyceride (TG) FAs and markers of inflammation, insulin resistance, nutritional status and body composition. Plasma TG-FAs were measured using gas chromatography in 341 patients on HD (age = 55.2 ± 14.0 years and 54.3% males). Cross-sectional associations of TG-FAs with 13 markers were examined using multivariate linear regression adjusted for potential confounders. Higher levels of TG saturated fatty acids were associated with greater body mass index (BMI, r = 0.230), waist circumference (r = 0.203), triceps skinfold (r = 0.197), fat tissue index (r = 0.150), serum insulin (r = 0.280), and homeostatic model assessment of insulin resistance (r = 0.276), but lower malnutrition inflammation score (MIS, r = − 0.160). Greater TG monounsaturated fatty acid levels were associated with lower lean tissue index (r = − 0.197) and serum albumin (r = − 0.188), but higher MIS (r = 0.176). Higher levels of TG n-3 polyunsaturated fatty acids (PUFAs) were associated with lower MIS (r = − 0.168) and interleukin-6 concentrations (r = − 0.115). Higher levels of TG n-6 PUFAs were associated with lower BMI (r = − 0.149) but greater serum albumin (r = 0.112). In conclusion, TG monounsaturated fatty acids were associated with poor nutritional status, while TG n-3 PUFAs were associated with good nutritional status. On the other hand, TG saturated fatty acids and TG n-6 PUFAs had both favorable and unfavorable associations with nutritional parameters.

Comparative Performance of Body Composition Parameters in Prediction of Death in Hospitalized Patients on Maintenance Hemodialysis: A Cohort Study

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.

P1580LONGITUDINAL CHANGES IN BODY COMPOSITION ARE ASSOCIATED WITH ALL-CAUSE MORTALITY IN PATIENTS ON PERITONEAL DIALYSIS

Abstract Background and Aims Peritoneal dialysis (PD) is associated with a number of adverse body compositional changes, including fat gain and muscle wasting. Whether body compositional changes are associated with the long-term prognosis is uncertain. The purpose of this study was to analyze the effects of longitudinal changes in body composition on all-cause mortality in PD patients. Method PD patients were subjected to bioimpedance spectroscopy (BIS) and handgrip strength (HGS) at baseline and after 2 years. Among 160 patients, 131 patients were tested with a repeat BIS and HGS. Lean tissue index (LTI) loss and fat tissue index (FTI) gain were defined as a 10% decline in LTI and a 10% gain in FTI, respectively after 2 years. Results The prevalence of sarcopenia at baseline was 13.8%. After 2 years, LTI loss and FTI gain were observed in 40 (30.5%) and 58 (44.3%) patients, respectively. Baseline clinical factors did not predict longitudinal body compositional changes, and there was a negative association between changes in the LTI and FTI (r = –0.574, p &amp;lt; 0.001). Low LTI and low HGS at baseline were significant predictors of all-cause mortality after adjusting for demographic and biochemical parameters, but not when cardiovascular factors were included in the multivariate analysis. However, LTI loss and FTI gain were independent risk factors for all-cause mortality after adjusting for demographic, biochemical, and cardiovascular parameters. Conclusion In PD patients, longitudinal changes in LTI and FTI were more strongly associated with all-cause mortality than single values in LTI and FTI.

Longitudinal changes in body composition are associated with all-cause mortality in patients on peritoneal dialysis.

Peritoneal dialysis (PD) is associated with a number of adverse body compositional changes, including fat gain and muscle wasting. Whether body compositional changes are associated with the long-term prognosis is uncertain. The purpose of this study was to analyze the effects of longitudinal changes in body composition on all-cause mortality in PD patients. PD patients were subjected to bioimpedance spectroscopy (BIS) and handgrip strength (HGS) at baseline and after 2 years. Among 160 patients, 131 patients were tested with a repeat BIS and HGS. Lean tissue index (LTI) loss and fat tissue index (FTI) gain were defined as a 10% decline in LTI and a 10% gain in FTI, respectively after 2 years. The prevalence of sarcopenia at baseline was 13.8%. After 2 years, LTI loss and FTI gain were observed in 40 (30.5%) and 58 (44.3%) patients, respectively. Baseline clinical factors did not predict longitudinal body compositional changes, and there was a negative association between changes in the LTI and FTI (r=-0.574, p<0.001). Low LTI and low HGS at baseline were significant predictors of all-cause mortality after adjusting for demographic and biochemical parameters, but not when cardiovascular factors were included in the multivariate analysis. However, LTI loss and FTI gain were independent risk factors for all-cause mortality after adjusting for demographic, biochemical, and cardiovascular parameters. In PD patients, longitudinal changes in LTI and FTI were more strongly associated with all-cause mortality than single values in LTI and FTI.

Association of Body Composition and Intradialytic Hypotension in Hemodialysis Patients

Background/Aim: The relationship between body mass index (BMI) and intradialytic hypotension (IDH) has been inconsistently reported, but no further research has investigated the correlation between body composition and IDH so far. This study aimed to determine whether the lean tissue index (LTI), fat tissue index (FTI), or both derived from body composition monitoring (BCM) is associated with IDH defined as a nadir intradialytic systolic blood pressure of <90 mm Hg and ≥3 episodes hypotension per 10 hemodialysis (HD) treatments in patients undergoing prevalent HD. Methods: The observational cohort study comprised 1,463 patients receiving thrice-weekly HD from 13 dialysis centers. LTI and FTI were assessed using a BCM machine, a multifrequency bioimpedance spectroscopy device. Unadjusted and multivariable adjusted logistic regression models were fit to estimate the association of body composition with the odds of developing IDH. Results: One hundred and seven patients (7.3%) were diagnosed as IDH. The difference in dialysis vintage, BMI, FTI, LTI, high-density lipoprotein cholesterol, and C-reactive protein between IDH and non-IDH groups was statistically significant (all p < 0.05). The prevalence of diabetes among IDH patients was slightly higher than among non-IDH patients. In logistic regression models, low LTI and high FTI, but not high BMI were associated with greater odds of IDH (“high” as above median and “low” as below median). When patients were further stratified into 4 distinct body composition groups based on both the LTI and FTI, only the low LTI/high FTI group was connected with a significantly higher odds of IDH (OR 2.686, 95% CI 1.072–6.734; reference: low LTI/low FTI group). Conclusions: The LTI and FTI can provide better correlation of IDH occurrence than the BMI alone in prevalent HD patients. The low LTI/high FTI appears to be most associated with IDH. An optimal body composition for preventing the occurrence of IDH needs to be determined.