title: Sarcopenic Obesity Definitions by Body Composition and Mortality in the Hemodialysis Patients.
abstract: Sarcopenic obesity (SO), a combination of low muscle mass and high fat mass, is considered as risk factor for mortality in general population. It is unclear if SO affects mortality in maintenance hemodialysis (MHD) patients. In this study, we aimed to determine whether body composition as assessed by currently available SO definitions is related to all-cause mortality in MHD subjects. We also examined the impact of applying different definitions on the prevalence of SO in our MHD database.
  
  
  
  Retrospective analysis.
  
  
  
  Adult patients on MHD for at least 3 months with no acute illness studied in the clinical research center between 2003 and 2011.
  
  
  
  Assessment of body composition was performed using dual energy x-ray absorptiometry. SO (appendicular skeletal mass: arm lean mass + leg lean mass and fat mass) was defined according to Baumgartner definition, Janssen criteria 1, and Janssen criteria 2.
  
  
  
  All-cause mortality and prevalence of SO. Patient deaths were ascertained from medical records and United States social security death index.
  
  
  
  Of 122 participants, 62% were male; mean age was 46 years (interquartile range: 40, 54) in men and 50 years (44, 61) in women. Prevalence of SO ranged from 12% to 62% in men and 2% to 74% in female according to different definitions. SO prevalence was lowest using the Baumgartner criteria (all: 8%, men 12%, women: 2%) and highest according to the Janssen criteria 2 (all: 57%, men 46%, women 74%). There were 45 deaths during a median follow-up period of 44 (20, 76) months. SO by any definition was not statistically significantly associated with mortality during follow-up.
  
  
  
  The current SO definitions are not applicable to predict increased risk of death in MHD patients. We found high degree of variation in the rates of SO when using different definitions. Future studies should focus on establishing MHD population-specific thresholds of muscle mass and adiposity for accurate prognostication.
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Malhotra
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Serpil M
authors.initials: SM
authors.lastname: Deger
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Huzaifah
authors.initials: H
authors.lastname: Salat
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Aihua
authors.initials: A
authors.lastname: Bian
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Stewart
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Cindy
authors.initials: C
authors.lastname: Booker
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Andrew
authors.initials: A
authors.lastname: Vincz
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Brianna
authors.initials: B
authors.lastname: Pouliot
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Tennessee Valley Healthcare System (TVHS), Veterans Administration (VA) Medical Center, Veteran's Health Administration, Nashville, Tennessee; Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: Alp.Ikizler@vanderbilt.edu.
authors.forename: T Alp
authors.initials: TA
authors.lastname: Ikizler
mesh_terms: D015502:Absorptiometry, Photon; D050154:Adiposity; D000328:Adult; D001823:Body Composition; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis* / Q000453:epidemiology; D015995:Prevalence; D006435:Renal Dialysis / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D055948:Sarcopenia / Q000175:diagnosis* / Q000453:epidemiology