Lean body mass predicts long-term survival in Chinese patients on peritoneal dialysis.
BACKGROUND
Reduced lean body mass (LBM) is one of the main indicators in malnutrition inflammation syndrome among patients on dialysis. However, the influence of LBM on peritoneal dialysis (PD) patients' outcomes and the factors related to increasing LBM are seldom reported.


METHODS
We enrolled 103 incident PD patients between 2002 and 2003, and followed them until December 2011. Clinical characteristics, PD-associated parameters, residual renal function, and serum chemistry profiles of each patient were collected at 1 month and 1 year after initiating PD. LBM was estimated using creatinine index corrected with body weight. Multiple linear regression analysis, Kaplan-Meier survival analysis, and Cox regression proportional hazard analysis were used to define independent variables and compare survival between groups.


RESULTS
Using the median LBM value (70% for men and 64% for women), patients were divided into group 1 (n = 52; low LBM) and group 2 (n = 51; high LBM). Group 1 patients had higher rates of peritonitis (1.6 vs. 1.1/100 patient months; p<0.05) and hospitalization (14.6 vs. 9.7/100 patient months; p<0.05). Group 1 patients also had shorter overall survival and technique survival (p<0.01). Each percentage point increase in LBM reduced the hazard ratio for mortality by 8% after adjustment for diabetes, age, sex, and body mass index (BMI). Changes in residual renal function and protein catabolic rate were independently associated with changes in LBM in the first year of PD.


CONCLUSIONS
LBM serves as a good parameter in addition to BMI to predict the survival of patients on PD. Preserving residual renal function and increasing protein intake can increase LBM.
Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Jenq-Wen
JW
Huang
Yu-Chung
YC
Lien
Hon-Yen
HY
Wu
Chung-Jen
CJ
Yen
Chun-Chun
CC
Pan
Tsai-Wei
TW
Hung
Chi-Ting
CT
Su
Chih-Kang
CK
Chiang
Hui-Teng
HT
Cheng
Kuan-Yu
KY
Hung
D000328:Adult; D000368:Aged; D044466:Asian People; D015992:Body Mass Index; D001835:Body Weight; D002681:China; D003404:Creatinine / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models
D003404:Creatinine