Factors associated with body-fat changes in prevalent peritoneal dialysis patients.
BACKGROUND
Changes in body fat (BF) were shown to occur over time in peritoneal dialysis (PD) patients. However, the factors associated with BF changes have not been fully investigated in this population.


METHODS
We studied 45 patients (25 were male; age, 53, SD +/- 15 years; 21 continuous ambulatory peritoneal dialysis/24 automated peritoneal dialysis; PD vintage, 14 ([range, 3 to 104] months; 40% were diabetic; 31% were previously treated by hemodialysis). Body composition was assessed by dual-energy X-ray absorptiometry and bioelectric impedance analysis, nutritional status was assessed by subjective global assessment, energy intake was assessed by 3-day food records, and resting energy expenditure (REE) was assessed by indirect calorimetry. Glucose absorption, serum bicarbonate, and C-reactive protein were also evaluated. All measurements were performed at baseline and after 12 months.


RESULTS
Large variability in BF changes was observed among patients: 53% gained BF (+3.0 +/- 2.8), whereas 47% lost BF (-2.3, SD +/- 1.4). At baseline, groups were similar regarding sex, age, percent diabetics, DP modality, characteristics of peritoneal transport, residual renal function, energy intake, glucose absorption, and REE. However, patients who gained BF had lower BF (16.3, SD +/- 6.9 kg, versus 20.9, SD +/- 6.5 kg; P = .03), had a higher ratio of total energy offered (intake plus absorbed glucose) to REE (1.45, SD +/- 0.39, versus 1.26, SD +/- 0.24; P = .04), and were on PD for a shorter time (10 [range, 3 to 104] versus 20 [range, 4 to 76] months; P = .03). This group also had a higher proportion of malnourished patients (50% versus 19%; P = .03) and of patients previously treated by hemodialysis (46% versus 14%; P = .03). After 12 months, a reduction in the frequency of malnutrition (50% to 25%; P = .02) was observed in the group of patients with increased BF. Patients who lost BF reduced their body cell mass (from 21.7 [SD +/- 5.1 kg] to 20.7 [SD +/- 5.0 kg]; P < .01) and level of serum bicarbonate (from 22.7 [SD +/- 3.7 mmol/L] to 20.9 [SD +/- 3.1 mmol/L]; P < .01). Moreover, this group had an increase in frequency of malnutrition (from 19% to 38%; P = .02), a reduction in the proportion of patients with residual renal function (from 62% to 43%; P = .03), and a higher number of hospitalizations (from 25% to 4%; P = .02) during follow-up. Glucose absorption and C-reactive protein were not associated with BF changes. A regression analysis showed that baseline body mass index was independently associated with a gain of BF (-0.19, SE = 0.09, P = .04), and that hospitalization during follow-up was associated with a loss of BF (2.35, SE = 1.19, P = .04).


CONCLUSIONS
Prevalent PD patients exhibited a large variability in BF changes. Baseline body mass index and hospitalizations during follow-up were the most important factors associated with these changes.
Vasselai
Priscila
P
Nutrition Program, Federal University of São Paulo, São Paulo, Brazil.
Kamimura
Maria Ayako
MA
Bazanelli
Ana Paula
AP
Pupim
Lara Bezas
LB
Avesani
Carla Maria
CM
da Mota Ribeiro
Fabiana Sanches
FS
Manfredi
Silvia Regina
SR
Draibe
Sérgio Antônio
SA
Cuppari
Lilian
L
D015502:Absorptiometry, Photon / Q000379:methods; D000273:Adipose Tissue / Q000378:metabolism*; D001481:Basal Metabolism / Q000502:physiology*; D001823:Body Composition / Q000502:physiology*; D002153:Calorimetry, Indirect; D015930:Diet Records; D017097:Electric Impedance; D002149:Energy Intake / Q000502:physiology; D004734:Energy Metabolism / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010530:Peritoneal Dialysis; D011237:Predictive Value of Tests; D011446:Prospective Studies