title: Accelerated lean body mass loss in incident chronic dialysis patients with diabetes mellitus.
abstract: BACKGROUND
  End-stage renal disease (ESRD) patients display a higher incidence of poor nutritional status and are at high risk of hospitalization and death. Patients on renal replacement therapy (RRT) with a primary diagnosis of diabetes mellitus have the lowest survival rates along with highest hospitalization incidence.
  
  
  METHODS
  In this study, we examined the importance of diabetes mellitus along with certain demographic and clinical variables in predicting the change in lean body mass (LBM) by dual-energy x-ray absorptiometry (DEXA), as a surrogate marker of somatic protein stores, in 142 incident ESRD patients (91 males, 52.8 +/- 1.0 years, 74.2 +/- 1.2 kg body weight) among which 34 had diabetes mellitus (19 insulin-dependent and 15 noninsulin dependent).
  
  
  RESULTS
  Our results show that patients with diabetes mellitus had significantly accelerated loss of LBM compared to nondiabetic patients during the first year of RRT (3.4 +/- 0.6 kg vs. 1.1 +/- 0.2 kg) (P < 0.05). Multivariate linear regression analyses revealed that the presence of diabetes mellitus was the strongest predictor of LBM loss independently of several clinically-relevant variables such as age, gender, serum albumin, presence of malnutrition, presence of inflammation, and RRT modality.
  
  
  CONCLUSIONS
  We conclude that the presence of diabetes mellitus is the most significant independent predictor of LBM loss in renal replacement therapy patients, providing a potential explanation as to why ESRD patients with diabetes mellitus are more prone to muscle wasting.
authors.affiliation: Division of Nephrology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Lara B
authors.initials: LB
authors.lastname: Pupim
authors.forename: Olof
authors.initials: O
authors.lastname: Heimbürger
authors.forename: Abdul Rashid
authors.initials: AR
authors.lastname: Qureshi
authors.forename: T Alp
authors.initials: TA
authors.lastname: Ikizler
authors.forename: Peter
authors.initials: P
authors.lastname: Stenvinkel
mesh_terms: D015502:Absorptiometry, Photon; D015992:Body Mass Index; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009133:Muscular Atrophy / Q000453:epidemiology*; D009752:Nutritional Status; D011237:Predictive Value of Tests; D017582:Renal Replacement Therapy