title: Reliability of bioelectrical impedance analysis in the evaluation of the nutritional status of hemodialysis patients - a comparison with Mini Nutritional Assessment.
abstract: BACKGROUND
  Protein-energy wasting (PEW) is a strong predictive factor for morbidity and mortality in patients who have end-stage renal disease (ESRD). Mini Nutritional Assessment (MNA) is an important and confirmed tool to evaluate PEW that has been recommended by many guidelines. Bioelectrical impedance analysis (BIA) is a noninvasive technique for assessing body composition. The aim of the present study was to analyze the reliability of BIA in malnutrition diagnosis by comparing it with standard MNA in a group of 100 ESRD patients.
  
  
  METHODS
  One hundred ESRD patients who were medically stable and under dialysis treatment for at least 6 months were enrolled to the study. Monthly assessed serum creatinine, albumin, C-reactive protein (CRP), and lipid profiles from the last 6 months prior to the study were retrospectively collected. A standard Full-MNA and body composition analyses were applied to all patients. Body compositions were analyzed with the BIA technique using the Body Composition Analyzer (Tanita BC-420 MA; Tanita, Tokyo, Japan). Patients were classified into three groups according to MNA scores as PEW (n = 15, score <17), moderate PEW or risk group (n = 49, score 17-23.5), and well-nourished (n = 36, score ≥ 24) patients.
  
  
  RESULTS
  Mean duration of maintenance hemodialysis treatment was significantly shorter in the PEW group compared to both of the other groups described (P = .015). Well-nourished and risk groups had lower CRP and higher albumin levels compared to PEW patients; however, these values were statistically similar in these two groups (P = .018, .01, respectively). According to BIA findings, well-nourished patients had the highest fat ratio, fat mass, muscle mass, visceral fat mass, and fat-free mass compared to both moderate the PEW/risk and the PEW groups (P < .05). Risk group patients also had higher muscle mass, visceral fat mass, and fat-free mass values compared to the PEW group (P < .05). A correlation analysis revealed that MNA scores were positively correlated with albumin (P = .005), creatinine (P = .049), fat mass (P = .045), muscle mass (P = .001), visceral fat ratio (P = .007), and BMI (P = .047) and in negative correlation with CRP (r = -0.357, P = .0001) levels.
  
  
  CONCLUSIONS
  We recommend BIA as a complementary diagnostic tool to evaluate nutritional status of ESRD along with MNA, anthropometric measures, and classical biochemical markers.
authors: Department of Internal Medicine, Baskent University Faculty of Medicine, Ankara, Turkey.
authors: E
authors: E
authors: Erdoğan
authors: E
authors: E
authors: Tutal
authors: M E
authors: ME
authors: Uyar
authors: Z
authors: Z
authors: Bal
authors: B G
authors: BG
authors: Demirci
authors: B
authors: B
authors: Sayın
authors: S
authors: S
authors: Sezer
mesh_terms: D000328:Adult; D000368:Aged; D000886:Anthropometry; D015415:Biomarkers / Q000097:blood; D001823:Body Composition; D002097:C-Reactive Protein / Q000378:metabolism; D003404:Creatinine / Q000097:blood; D017097:Electric Impedance; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D011237:Predictive Value of Tests; D011502:Protein-Energy Malnutrition / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D006435:Renal Dialysis / Q000009:adverse effects; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D000075462:Serum Albumin, Human; D013997:Time Factors
chemical_list: C422455:ALB protein, human; D015415:Biomarkers; D008055:Lipids; D012709:Serum Albumin; D002097:C-Reactive Protein; D003404:Creatinine; D000075462:Serum Albumin, Human