The Phase Angle and Mass Body Cell as Markers of Nutritional Status in Hemodialysis Patients (original) (raw)
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Gaceta Médica de México, 2019
Introduction: Multi-frequency bio-impedance analysis (BIA) accurately evaluates body composition. Objective: To assess nutritional status and its relationship with body mass index (BMI) or with BIA-obtained phase angle in patients with end-stage renal disease (ESRD) on hemodialysis. Method: BMI, BIA and dialysis malnutrition score (DMS) were assessed in 99 patients on hemodialysis (43.6 ± 17.2 years of age, 58.8% males). Multivariate linear regression analysis was used to determine BMI and phase angle independent associations with DMS. Results: Malnutrition risk (DMS > 13) showed a gradual increase among patients with normal BMI and phase angle (44.4%), low BMI (45.8%), low phase angle (64.0%), and in those with both parameters at abnormal ranges (68.0%). The phase angle was the only variable that was independently associated with patient nutritional status (standardized coefficient beta −0.372, p < 0.001), accounting for 13.8% of DMS variation. Conclusion: Phase angle is inversely and independently associated with malnutrition risk in patients with ESRD, which suggests that BIA-assessed body composition might be better than BMI in the clinical assessment of patients with ESRD.
Nutritional Markers and Body Composition in Hemodialysis Patients
The aims of this study were to analyse body composition, to detect the presence of undernutrition, and to establish a relationship between undernutrition and the biological markers routinely used as indicators of nutritional status in hemodialysis (HD) patients (pts). We used a body composition monitor (BCM) that expresses body weight in terms of lean tissue mass (LTM) and fat tissue mass (FTM) independent of hydration status. From nine HD units, 934 pts were included. Undernutrition was defined as having 2a lean tissue index (LTI = LTM/height ) below the 10th percentile of a reference population. Biochemical markers and parameters delivered by BCM were used to compare low LTI and normal LTI groups. Undernutrition prevalence was 58.8% of the population studied. Low LTI pts were older, were significantly more frequently overhydrated, and had been on HD for a longer period of time 2than the normal LTI group. FTI (FTI = FTM/ height ) was significantly higher in low LTI pts and increased according to BMI. LTI was not influenced by different BMI levels. Albumin and C-reactive protein correlated inversely (r = −0.28). However neither of them was statistically different when considering undernourished and normal LTI pts. Our BCM study was able to show a high prevalence of undernutrition, as expressed by low LTI. In our study, BMI and other common markers, such as albumin, failed to predict malnutrition as determined by BCM.
Physical methods for evaluating the nutrition status of hemodialysis patients
Journal of nephrology, 2015
This article aims to provide an overview of the different nutritional markers and the available methodologies for the physical assessment of nutrition status in hemodialysis patients, with special emphasis on early detection of protein energy wasting (PEW). Nutrition status assessment is made on the basis of anamnesis, physical examination, evaluation of nutrient intake, and on a selection of various screening/diagnostic methodologies. These methodologies can be subjective, e.g. the Subjective Global Assessment score (SGA), or objective in nature (e.g. bioimpedance analysis). In addition, certain biochemical tests may be employed (e.g. albumin, pre-albumin). The various subjective-based and objective methodologies provide different insights for the assessment of PEW, particularly regarding their propensity to differentiate between the important body composition compartments-fluid overload, fat mass and muscle mass. This review of currently available methods showed that no single app...
Nutrition parameters as hemodialysis adequacy markers
Hippokratia
Background and aim: The nutritive status has significant role in improving the quality of life of dialysis' patients. The aim of this study was to find out if there is any correlation of the anthropometric parameters and markers of nutrition with the adequacy of HD.Methods: The investigation was organized as a clinical, cross sectional study. Demographic characteristics, co-morbid conditions, smoking, dialysis duration and blood pressure were recorded. Serum total protein, albumin, ferritin and blood-lipids were measured as biochemical markers of nutritional status.One hundred and forty patients, 82 (58.6%) male, and 58 (41.4%) female, 55±12.59 years, were dividied into two groups. Group A consisted of 44 patients (14 women and 30 men) received the recommended hemodialysis dose (Kt/V ≥ 1.2), while the Group B consisted of 96 patients (69 males and 27 females) received non-adequate hemodialysis dose (Kt/V < 1.2).Results: Patients with adequate hemodialysis had been longer on d...
Parameters to assess nutritional status in a Moroccan hemodialysis cohort
Arab journal of nephrology and transplantation, 2013
Malnutrition is common in maintenance hemodialysis (HD) and is associated with increased mortality and morbidity in affected patients. The aim of this study was to determine the prevalence of malnutrition and correlate the methods of nutritional assessment. We evaluated the nutritional status of 40 prevalent HD patients by subjective global assessment (SGA) score, anthropometrics [body mass index (BMI), arm circumference (AC), triceps skin-fold thicknesses (TSF), arm muscle circumference (AMC)], biochemical tests [normalized protein equivalent to total nitrogen appearance (nPNA), and pre-dialysis serum albumin and serum prealbumin levels] and bio-electrical impedance (BEI) analysis to estimate body composition [lean tissue index (LTI) and fat tissue index (FTI)]. The study assessed 40 patients (20 males and 20 females) with a mean age of 50.7±16.5 years. The prevalence of malnutrition according to the different methods ranged from 5 % to 65%. There were highly significant gender-spe...
Dialysis adequacy and nutritional status of hemodialysis patients
Hemodialysis International, 2008
To characterize the nutritional status of renal failure patients and its relationship with hemodialysis adequacy measured by Kt/V, a study was carried out with a population of 44 adult patients with renal failure and mean age 51 AE 15 years. Anthropometric data, such as dry weight, height, arm circumference, triceps skinfold thickness, mid-arm muscle circumference, and body mass index were assessed, and biochemical tests were conducted for urea, potassium, creatinine, serum albumin, and phosphorus levels, in addition to hemogram and quarterly urea reduction rate average (Kt/V). In order to evaluate calorie intake, a dietary questionnaire on habitual daily food ingestion was administered, taking into consideration the hemodialysis date. The patients were divided into 2 separate groups for the statistical analysis, with 50% of the patients in each group: A (Kt/Vo1.2) and B (Kt/V41.2). The data were tabulated as mean and standard deviation, with differences tested by Student's t test. The correlations between variables were established by the coefficient p of Pearson. Most of the patients (43%) were considered eutrophic, based on the BMI, and presented inadequate calorie intake, corresponding to 88.5 AE 24% (30.8 kcal/kg actual weight) of the total energy required and adequate protein intake, reaching 109.9 AE 40% of the recommended daily allowance (1.24 g/kg of actual weight). There was a correlation of Kt/V with anthropometric parameters such as body mass index, arm circumference, and mid-arm muscle circumference. The biochemical parameters related to dialysis adequacy were albumin, ferritin, and urea (predialysis). Well-dialyzed patients presented better levels of serum albumin. There was an influence of gender and age on correlations of the analyzed variables. Female and younger patients presented better dialysis adequacy. The dialysis adequacy was related to the nutritional status and influenced by the protein intake and body composition. Gender and age had an important influence in the dialysis adequacy, as men presented lower dialysis adequacy and younger adults presented better dialysis adequacy. Further research is necessary to understand better how to facilitate effective and efficient techniques for the nutritional status assessment of hemodialysis patients.
Assessment of the Nutritional Status of the Hemodialysis Patients by Anthropometric Measurements
Cureus, 2021
This study assessed the nutritional status of end-stage renal disease (ESRD) patients on maintenance hemodialysis (MHD) by utilizing bedside anthropometric measurements. Methods This prospective cross-sectional study was done from November 2020 till April 2021 on ESRD patients three times a week MHD at our centre. Anthropometric measurements including body mass index (BMI), triceps skinfold thickness (TSFT), mid-arm circumference (MAC), calf circumference (CC) and handgrip strength (HGS) were measured mid-arm muscle circumference (MAMC) was calculated, and nutritional status was determined. Results Out of 195 patients recruited in our study, 127 (65.1%) were male. The mean age was 51.2 ± 14.8 years with a minimum of 20 and a maximum of 90 years, while the mean duration of HD was 4.6 ± 4.1 years. The majority of our patients had TSFT of 60 % to 90% 93 (47.7%), indicating mild to moderate depletion of fat stores and MAMC of >90 % 128 (65.6%), indicating good protein stores. Among all anthropometric measures, BMI was strongly associated with age (<0.001), while gender and duration of MHD were associated with TSFT (p <0.001). Conclusion Anthropometric measurements are easy and inexpensive bedside methods for assessing the nutritional status of ESRD patients on MHD. Our study concluded that our MHD patients have overall good nutritional status, though our young patients have low BMI and old have obesity. Male patients have weaker HGS. With the increased number of years on MHD, malnutrition increases. Our study will help to treat physicians and nutritionists for proper nutritional planning and implementation to prevent malnutrition.
Nutritional and prognostic correlates of bioimpedance indexes in hemodialysis patients
Kidney International, 1996
Nutritional and prognostic correlates of bioimpedance indexes in hemodialysis patients. We carried out a cross sectional and longitudinal study to assess whether bioimpedance indexes (resistance, Rz; reactance, Xc; phase angle, PA) reflect the nutritional status of hemodialysis (HD) patients, and bear a significant association with their long-term survival. The bioimpedancc data of 131 patients on chronic HD treatment were compared with those of 272 healthy controls matched for age and sex. Nutritional status was assessed by anthropometric variables, serum albumin (SA), normalized protein catabolic rate (nPCR), and subjective global assessment (SGA). All three hioimpedance indexes varied significantly with HD treatment, however, with the exception of Xc in post-HD, they were on average significantly (P < 0.016) different from controls either pre-and post-HD. Post-HD PA appeared to be the best index of nutritional status, being significantly correlated with SA, age, mid arm muscle circumference (MAMC), SGA, and nPCR (R2 = 0.44; P < 0.01).
Nutrition and Metabolic Insights, 2015
OBJECTIVE: To assess the nutritional status of patients on maintenance hemodialysis by using modified quantitative subjective global assessment (MQSGA) and anthropometric measurements. METHOD: We Conducted a cross sectional descriptive analytical study to assess the nutritional status of fifty four patients with chronic kidney disease undergoing maintenance hemodialysis by using MQSGA and different anthropometric and laboratory measurements like body mass index (BMI), mid-arm circumference (MAC), mid-arm muscle circumference (MAMC), triceps skin fold (TSF) and biceps skin fold (BSF), serum albumin, C-reactive protein (CRP) and lipid profile in a government tertiary hospital at Kathmandu, Nepal. RESULTS: Based on MQSGA criteria, 66.7% of the patients suffered from mild to moderate malnutrition and 33.3% were well nourished. None of the patients were severely malnourished. CRP was positive in 56.3% patients. Serum albumin, MAC and BMI were (mean + SD) 4.0 + 0.3 mg/dl, 22 + 2.6 cm and 19.6 ± 3.2 kg/m 2 respectively. MQSGA showed negative correlation with MAC (r =-0.563; P = 0.001), BMI (r = -0.448; P = 0.001), MAMC (r = -0.506; P = .0001), TSF (r = -0.483; P = .0002), and BSF (r = -0.508; P = 0.0001). Negative correlation of MQSGA was also found with total cholesterol, triglyceride, LDL cholesterol and HDL cholesterol without any statistical significance. CONCLUSION: Mild to moderate malnutrition was found to be present in two thirds of the patients undergoing hemodialysis. Anthropometric measurements like BMI, MAC, MAMC, BSF and TSF were negatively correlated with MQSGA. Anthropometric and laboratory assessment tools could be used for nutritional assessment as they are relatively easier, cheaper and practical markers of nutritional status.
Assessing the Nutritional Status of Hemodialysis Patients in a Sub-Saharan Country
Journal of Kidney, 2017
Objective: Identifying which of the three scores (MNA, SGA and ISRNM) would better assess the nutritional status of chronic hemodialysis patients in Benin Patients and Methods: We conducted a cross-sectional, descriptive and analytical study. It was carried out over a three-month period, from 1 st July to 31 st September 2015. The study participants included patients who have been on hemodialysis for at least the past 6 months, non-admitted in the past 4 weeks and having given their consent to participate in the study. All patients were subject to anthropometric parameters and checkups in order to apply the three nutritional scores: Mini Nutritional Assessment (MNA); Suggestive Global Assessment (SGA); International Society of Renal Nutrition and Metabolism (ISRNM criteria). Statistical analysis was performed through EpiData Ver 3.1. Outcomes: 149 patients were selected including 38.93% of women and 61.07% of men. Age ranged from 19 to 79 years with 48 ± 12.88 as mean age. The prevalence of overall malnutrition was respectively 42.75%; 36.24% and 14.09% based on MNA, SGA and ISRNM scores. There was poor protein intake in 85.19% of cases, body mass index (BMI) was below 23 kg/m ² in 68.46% of cases, hypoalbuminemia and pre-dialysis hypocreatininemia were recorded in respectively 29.53% and 52.38% of cases. Conclusion: SGA score seems to be a more objective score as it uses both history and clinical data. BMI and protein intake when considered distinctly, have a better predictive value of our patients nutritional status.