Журнал нефрологии и терапии

Body Composition, Nutritional Status and Mortality in Peritoneal Dialysis Patients

Abstract

Morrell M. Avram, Paul A. Fein, Samuel Agahiu, William Hartman, and Jyotiprakas Chattopadhyay

Background: Protein energy malnutrition is highly prevalent and a risk factor for mortality in peritoneal dialysis (PD) patients. In this study we have investigated the association of body composition parameters with nutritional status and outcomes in PD patients. Methods: We enrolled 63 PD patients between November 2000 to May 2008. On enrollment, demographic, clinical and biochemical data were recorded. Patients were followed to May 2011. Body composition was determined by bioelectrical impedance analysis (BIA). Results: Mean age was 54 years. At enrollment, the mean (± SD) serum albumin, creatinine and nPCR were 3.71 ± 0.59 g/dL, 11.38 ± 4.2 mg/dL and 0.94 ± 0.27 g/kg/day respectively. Mean (± SD) body mass index (BMI), phase angle (PA) and extracellular mass/body cell mass (ECM/BCM) ratio were 25.37 ± 5.46 Lbs/inch2, 6.06 ± 1.6 degrees and 1.21 ± 0.2 respectively. Albumin, and creatinine directly correlated with BMI (p=0.027 for albumin; p<0.0001 for creatinine) and PA (p<0.0001 for albumin; p=0.031 for creatinine) and inversely correlated with ECM/BCM ratio (p=0.001 for albumin; p=0.07 for creatinine). During the study period 26 patients expired. Patients who survived had higher BMI (p=0.05), PA (p=0.017) and lower ECM/BCM ratio (p=0.04) compared to those who expired. In Cox’s multivariate analysis, adjusting for confounding variables, higher levels of PA (Relative risk: 0.52, p=0.009) and lower levels of ECM/BCM ratio (Relative risk: 1.039, p=0.035) were significantly and independently associated with increased survival in PD patients followed up to 11 years. Conclusions: Estimates of BMI, PA and ECM/BCM ratio reflect nutritional status and are important predictors of long term survival in PD patients. It may be useful to incorporate these parameters in the management of malnutrition and overall health in these patients.