Accelerated lean body mass loss in incident chronic dialysis patients with diabetes mellitus.
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.
Pupim
Lara B
LB
Division of Nephrology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Heimbürger
Olof
O
Qureshi
Abdul Rashid
AR
Ikizler
T Alp
TA
Stenvinkel
Peter
P
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