Mid-arm muscle circumference and quality of life and survival in maintenance hemodialysis patients.
OBJECTIVE
Maintenance hemodialysis (MHD) patients with larger body or fat mass have greater survival than normal to low mass. We hypothesized that mid-arm muscle circumference (MAMC), a conveniently measured surrogate of lean body mass (LBM), has stronger association with clinical outcomes than triceps skinfold (TSF), a surrogate of fat mass.


METHODS
The associations of TSF, MAMC, and serum creatinine, another LBM surrogate, with baseline short form 36 quality-of-life scores and 5-year survival were examined in 792 MHD patients. In a randomly selected subsample of 118 subjects, LBM was measured by dual-energy x-ray absorptiometry.


RESULTS
Dual-energy x-ray absorptiometry-assessed LBM correlated most strongly with MAMC and serum creatinine. Higher MAMC was associated with better short form 36 mental health scale and lower death hazard ratios (HRs) after adjustment for case-mix, malnutrition-inflammation-cachexia syndrome, and inflammatory markers. Adjusted death HRs were 1.00, 0.86, 0.69, and 0.63 for the first to fourth MAMC quartiles, respectively. Higher serum creatinine and TSF were also associated with lower death HRs, but these associations were mitigated after multivariate adjustments. Using median values of TSF and MAMC to dichotomize, combined high MAMC with either high or low TSF (compared with low MAMC/TSF) exhibited the greatest survival, i.e., death HRs of 0.52 and 0.59, respectively.


CONCLUSIONS
Higher MAMC is a surrogate of larger LBM and an independent predictor of better mental health and greater survival in MHD patients. Sarcopenia-correcting interventions to improve clinical outcomes in this patient population warrant controlled trials.
Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA.
Nazanin
N
Noori
Joel D
JD
Kopple
Csaba P
CP
Kovesdy
Usama
U
Feroze
John J
JJ
Sim
Sameer B
SB
Murali
Amanda
A
Luna
Myra
M
Gomez
Claudia
C
Luna
Rachelle
R
Bross
Allen R
AR
Nissenson
Kamyar
K
Kalantar-Zadeh
D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D001132:Arm / Q000033:anatomy & histology*; D001823:Body Composition; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000033:anatomy & histology*; D011788:Quality of Life; D006435:Renal Dialysis / Q000401:mortality* / Q000523:psychology*; D012885:Skinfold Thickness