title: Longitudinal Changes in Body Composition in Patients After Initiation of Hemodialysis Therapy: Results From an International Cohort.
abstract: OBJECTIVE
  In patients with advanced kidney disease, metabolic and nutritional derangements induced by uremia interact and reinforce each other in a deleterious vicious circle. Literature addressing the effect of dialysis initiation on changes in body composition (BC) is limited and contradictory. The aim of this study was to evaluate changes in BC in a large international cohort of incident hemodialysis patients.
  
  
  METHODS
  A total of 8,227 incident adult end-stage renal disease patients with BC evaluation within the initial first 6 months of baseline, defined as 6 months after renal replacement therapy initiation, were considered. BC, including fat tissue index (FTI) and lean tissue index (LTI), were evaluated by Body Composition Monitor (BCM, Fresenius Medical Care, Bad Homburg, Germany). Exclusion criteria at baseline were lack of a BCM measurement before or after baseline, body mass index (BMI) < 18.5 kg/m(2), presence of metastatic solid tumors, treatment with a catheter, and prescription of less or more than 3 treatments per week. Maximum follow-up was 2 years. Descriptive analysis was performed comparing current values with the baseline in each interval (delta analysis). Linear mixed models considering the correlation structure of the repeated measurements were used to evaluate factors associated with different trends in FTI and LTI.
  
  
  RESULTS
  BMI increased about 0.6 kg/m(2) over 24 months from baseline. This was associated with increase in FTI of about 0.95 kg/m(2) and a decrease in LTI of about 0.4 kg/m(2). Female gender, diabetic status, and low baseline FTI were associated with a significant greater increase of FTI. Age > 67 years, diabetes, male gender, high baseline LTI, and low baseline FTI were associated with a significant greater decrease of LTI.
  
  
  CONCLUSIONS
  With the transition to hemodialysis, end-stage renal disease patients presented with distinctive changes in BC. These were mainly associated with gender, older age, presence of diabetes, low baseline FTI, and high baseline LTI. BMI increases did not fully represent the changes in BC.
authors.affiliation: Fresenius Medical Care, Bad Homburg, Germany; Danube University, Krems, Austria. Electronic address: daniele.marcelli@fmc-ag.de.
authors.forename: Daniele
authors.initials: D
authors.lastname: Marcelli
authors.affiliation: Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Brand
authors.affiliation: NephroCare, Lisbon, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Ponce
authors.affiliation: NephroCare, Krakow, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Milkowski
authors.affiliation: Fresenius Medical Care, Buenos Aires, Argentina.
authors.forename: Cristina
authors.initials: C
authors.lastname: Marelli
authors.affiliation: Division of Nephrology, Ege University, Izmir, Turkey.
authors.forename: Ercan
authors.initials: E
authors.lastname: Ok
authors.affiliation: NephroCare, Madrid, Spain.
authors.forename: José-Ignacio
authors.initials: JI
authors.lastname: Merello Godino
authors.affiliation: NephroCare, St. Petersburg, Russia.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Gurevich
authors.affiliation: NephroCare, Prague, Czech Republic.
authors.forename: Tomáš
authors.initials: T
authors.lastname: Jirka
authors.affiliation: NephroCare, Kosice, Slovak Republic.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Rosenberger
authors.affiliation: NephroCare, Naples, Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Di Benedetto
authors.affiliation: NephroCare Nephrology Center, Miskolc, Hungary.
authors.forename: Erzsébet
authors.initials: E
authors.lastname: Ladányi
authors.affiliation: Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Aileen
authors.initials: A
authors.lastname: Grassmann
authors.affiliation: Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Laura
authors.initials: L
authors.lastname: Scatizzi
authors.affiliation: Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Inga
authors.initials: I
authors.lastname: Bayh
authors.affiliation: Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Kooman
authors.affiliation: Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Bernard
authors.initials: B
authors.lastname: Canaud
mesh_terms: D050154:Adiposity; D000293:Adolescent; D000328:Adult; D000368:Aged; D001823:Body Composition; D015992:Body Mass Index; D017097:Electric Impedance; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D007843:Latin America; D008137:Longitudinal Studies; D008875:Middle Aged; D006435:Renal Dialysis; D013019:South Africa; D055815:Young Adult