title: Body composition monitoring and nutrition in maintenance hemodialysis and CAPD patients--a multicenter longitudinal study.
abstract: Hydration and nutritional status of end stage renal disease (ESRD) patients are linked to increased morbidity and mortality. Body composition monitoring (BCM) by multi-frequency bioimpedance spectroscopy (MFBS) is considered to be a superior modality of fluid assessment in chronic kidney disease (CKD) dialysis. We did a longitudinal prospective study in South India on maintenance hemodialysis (MHD) and continuous ambulatory peritoneal dialysis (CAPD) patients over 24 months and looked at impact of baseline nutritional parameters and body composition parameters on 24-month mortality. Ninety-nine patients stable on dialysis for at least 3 months were recruited (MHD 85, CAPD 14) at baseline and at 24 months, 41 were alive and 33 had expired, 12 had undergone renal transplant and 13 were lost to follow-up. BCM and nutritional assessment were done at baseline and at follow-up. Baseline overhydration (OH) differed significantly between surviving and dead patients (p < 0.05). Receiver operating characteristic (ROC) curve between OH and mortality showed that the best cut-off point to differentiate between survived and expired patients was 3.15 L. ROC curve for BMI showed lower than cut-off of 22.65 kg/m(2) to predict mortality with sensitivity 41.30% and specificity 81.81%. At follow-up, triceps skin fold thickness (TSF), biceps skin fold thickness (BSF) and mid arm circumference (MAC) increased significantly from baseline (p < 0.001, p = 0.001 and p < 0.001, respectively). Overhydration and BMI are important predictors of mortality in dialysis patients. Improvement in anthropometric markers TSF, BSF and MAC in MHD patients was associated with survival.
authors.affiliation: Department of Nephrology and Nutrition, Pondicherry Institute of Medical Sciences , Puducherry , India .
authors.forename: Sharon
authors.initials: S
authors.lastname: Mathew
authors.forename: Georgi
authors.initials: G
authors.lastname: Abraham
authors.forename: Madhusudan
authors.initials: M
authors.lastname: Vijayan
authors.forename: Thigarajan
authors.initials: T
authors.lastname: Thandavan
authors.forename: Milly
authors.initials: M
authors.lastname: Mathew
authors.forename: Ilangovan
authors.initials: I
authors.lastname: Veerappan
authors.forename: Laxmi
authors.initials: L
authors.lastname: Revathy
authors.forename: Merina E
authors.initials: ME
authors.lastname: Alex
mesh_terms: D000328:Adult; D000368:Aged; D000886:Anthropometry / Q000379:methods; D001823:Body Composition; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects / Q000379:methods; D011188:Potassium / Q000097:blood; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods; D016019:Survival Analysis; D014508:Urea / Q000097:blood; D014882:Water-Electrolyte Balance
chemical_list: D014508:Urea; D003404:Creatinine; D011188:Potassium
keywords: Hemodialysis; multi-frequency bioimpedance spectroscopy; overhydration; peritoneal dialysis; survival