Associations of body size and body composition with functional ability and quality of life in hemodialysis patients.
OBJECTIVE
Modifiable factors, such as body size and body composition, could influence physical function and quality of life in patients undergoing maintenance hemodialysis (MHD).


METHODS
From January 2008 to June 2012, in body mass index (BMI), waist circumference (WC), and magnetic resonance imaging measurements of midthigh muscle area (MTMA) and intra-abdominal fat area (IAFA) were obtained at baseline in 105 MHD patients. Six-minute walk distances and physical and mental component scores (PCS and MCS) from the Short Form-12 questionnaire were obtained at baseline and 6 and 12 months. Separate mixed-effects regression models were used to relate baseline BMI, WC, and IAFA with baseline and the average of follow-up 6-minute walk distances and PCS and MCS after adjustment for baseline covariates and MTMA.


RESULTS
for baseline covariates and baseline MTMA, each SD increase in baseline BMI was inversely associated with baseline (-31.5 m; 95% confidence interval [95% CI], -53.0 to -10.0 m) and follow-up (-36.9 m; 95% CI, -54.6 to -19.2 m) 6-minute walk distances. Results were similar for WC and IAFA. In each of these models, each SD increase in MTMA had a strong positive association with 6-minute walk distance. Adiposity measures were not associated with baseline or follow-up PCS and MCS. After adjustment for baseline BMI, each SD increase in baseline MTMA was associated with higher baseline PCS score (3.78; 95% CI, 0.73 to 6.82) and MCS (3.75; 95% CI, 0.44 to 7.05) but had weaker associations with follow-up PCS and MCS.


CONCLUSIONS
Body size and composition are significantly associated with physical functioning and quality of life. Interventions that improve muscle mass and decrease obesity might improve these measures in patients undergoing MHD.
Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah; Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah;
Macy
M
Martinson
Department of Medicine, Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee;
T Alp
TA
Ikizler
Utah Center for Advanced Imaging Research, Salt Lake City, Utah; and.
Glen
G
Morrell
Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah;
Guo
G
Wei
Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah; Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah;
Nestor
N
Almeida
Department of Physical Therapy, University of Utah College of Health, Salt Lake City, Utah.
Robin L
RL
Marcus
Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah;
Rebecca
R
Filipowicz
Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah;
Tom H
TH
Greene
Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah; Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah; srinivasan.beddhu@hsc.utah.edu.
Srinivasan
S
Beddhu
D000328:Adult; D000368:Aged; D001823:Body Composition; D015992:Body Mass Index; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D052097:Quadriceps Muscle / Q000033:anatomy & histology; D011788:Quality of Life; D006435:Renal Dialysis; D011795:Surveys and Questionnaires; D055105:Waist Circumference
chronic kidney disease; hemodialysis; quality of life