Departments of Renal Medicine and Transplantation, Barts Health NHS Trust, London, E1 1BB, UK.
Eur J Clin Nutr. 2019 Nov;73(11):1520-1528. doi: 10.1038/s41430-019-0391-3. Epub 2019 Jan 15.
BACKGROUND/OBJECTIVES: Bioimpedance analysis is often routinely performed in any dialysis unit to guide fluid management but can provide a reproduceable assessment of fat and muscle mass. We wished to determine the clinical significance of low muscle or high fat mass and the determinants that influence their change.
SUBJECTS/METHODS: We performed retrospective analysis of 824 patients on peritoneal dialysis who underwent routine repeated bioimpedance analysis measurements using the body composition monitor (BCM).
Lean tissue index (LTI) was an independent predictor of mortality when sex, age, PD vintage and diabetes status were included in the models (HR 0.93; 95% CI 0.86-1.00, p < 0.05) and when baseline serum albumin was included in a separate model (HR 0.86; 95% CI: 0.79-0.93, p < 0.001). High fat tissue index (FTI) was an independent predictor of mortality when demographic factors were included (HR 0.87; 95% CI: 0.78-0.97, p < 0.02), but not with the addition biochemical parameters. Changes in body composition of 206 patients over a 2-year follow-up period could not be predicted by baseline demographics, functional or biochemical assessments. However, there was a strong inverse relationship between changes in LTI and FTI. There were no associations between changes in body composition with prescribed dialysate glucose.
We showed body composition changes are common and complex. LTI was an independent predictor of survival. Changes in LTI and FTI could not be predicted by baseline parameters. BCM may be a sensitive and accurate tool to monitor changes in body composition during dialysis treatment.
背景/目的：生物阻抗分析常用于指导透析单位的液体管理，但也可以提供脂肪和肌肉量的可重复评估。我们希望确定低肌肉量或高脂肪量的临床意义，以及影响其变化的决定因素。
我们对 824 名接受腹膜透析的患者进行了回顾性分析，这些患者使用身体成分监测仪（BCM）进行了常规重复生物阻抗分析测量。
当将性别、年龄、PD 龄和糖尿病状态纳入模型时，瘦组织指数（LTI）是死亡率的独立预测因素（HR 0.93；95%CI 0.86-1.00，p<0.05），当在单独的模型中纳入基线血清白蛋白时，LTI 是死亡率的独立预测因素（HR 0.86；95%CI：0.79-0.93，p<0.001）。当纳入人口统计学因素时，高脂肪组织指数（FTI）是死亡率的独立预测因素（HR 0.87；95%CI：0.78-0.97，p<0.02），但加入生化参数后则不然。在 2 年的随访期间，206 名患者的身体成分变化无法通过基线人口统计学、功能或生化评估来预测。然而，LTI 和 FTI 的变化之间存在很强的反比关系。身体成分的变化与规定的透析液葡萄糖之间没有关联。
我们表明身体成分的变化是常见且复杂的。LTI 是生存的独立预测因素。LTI 和 FTI 的变化不能通过基线参数预测。BCM 可能是监测透析治疗期间身体成分变化的敏感和准确工具。
