Despite the importance of body composition in the prognosis of dialysis patients, there are few data available on comparisons of the prognostic value of varying nutritional and fluid load parameters in hospitalized patients on dialysis. Researchers conducted a prospective observational study designed to examine the association of varying parameters in body composition with all-cause mortality in in-hospital dialysis patients.
Body composition was measured by bioelectrical impedance within the initial 3 days of hospital admission. The parameters of fluid volume were overhydration (OH), the ratio of OH to extracellular water (OH/ECW), the ratio of ECW to body cell mass (ECW/BCM), and the ratio of ECW to intracellular water (ECW/ICW). Nutritional status parameters included fat tissue index (FTI), lean tissue index (LTI), and body cell mass index (BCMI).
The study included 832 patients. Median follow-up was 31 months. During follow-up, 23.0% (n=191) of the patients died. Multivariable Cox models revealed an association between higher ECW/BCM and a significantly increased risk of death. Lower LTI and BCMI were also associated with greater risk of death. There was an association between risk of death and BMI, FTI, and BCM/weight; however the magnitude of the association was greatest for ECW/BCM.
After adding ECW/BCM, LTI, and BCMI to the fully adjusted model, the predictability for all-cause mortality was improved only with LTI.
In conclusion, the researchers said, “ECW/BCM was the most relevant to mortality in fluid volume indices, and LTI and BCMI were the two most relevant to mortality in nutritional status indices. Higher LTI was significantly associated with lower risk of death and exhibited a stronger association with mortality than ECW/BCM, BCMI, and other body composition parameters in dialysis inpatients.”
Source: Mao H, Wu B. Comparative study of the prognostic value of body composition parameters in hospitalized patients with dialysis. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2019 (Abstract SA-PO830), November 9, 2019, Washington, DC.