a Department of Nephrology , Renji Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai , China.
b School of Nursing , Shanghai Jiao Tong University , Shanghai , China.
Ren Fail. 2019 Nov;41(1):377-383. doi: 10.1080/0886022X.2019.1608241.
Body composition monitoring is the only clinically available method for distinguishing among the three body components. This study aimed to determine the relationship between body composition and all-cause mortality in Chinese hemodialysis patients and examine whether the lean tissue index (LTI) derived from body composition monitoring can accurately diagnose malnourished patients.
Hemodialysis patients (n = 123) with nutritional and body composition assessment records in 2015 were examined. Body composition was assessed using a body composition monitor machine.
Fifty-seven patients (46.3%) had low LTI (LTI less than the 10th percentile of the respective normal distribution). Significant differences in the fat tissue index (FTI) were observed, with the low LTI group having a higher FTI (10.8 kg/m vs. 9.0 kg/m, p= .007). The kappa coefficient of agreement between LTI and subjective global assessment (SGA) was 0.26 for the presence of malnutrition. During the mean observation period of 26.7 months, 20 of 123 (16.3%) patients died. Low LTI remained highly predictive of survival in the Cox regression analysis (hazard ratio: 3.24, 95% confidence interval 1.06-9.91, p= .04). Malnourishment defined by SGA predicted survival in the Kaplan-Meier analysis (log-rank χ=4.05; p= .04) but not in the multivariate analysis.
LTI is a predictor of mortality, and its predictive power was not affected when FTI, SGA, and hydration status were included in the multivariate analysis. However, SGA may not be adequate to identify patients at a risk of death among Chinese hemodialysis patients.
身体成分监测是区分身体三个组成部分的唯一临床可用方法。本研究旨在确定身体成分与中国血液透析患者全因死亡率之间的关系，并探讨身体成分监测得出的瘦组织指数（LTI）是否能准确诊断营养不良患者。
检查了 2015 年有营养和身体成分评估记录的血液透析患者（n=123）。使用身体成分监测仪评估身体成分。
57 名患者（46.3%）的 LTI 较低（LTI 低于各自正常分布的第 10 百分位数）。观察到脂肪组织指数（FTI）存在显著差异，低 LTI 组的 FTI 更高（10.8kg/m 与 9.0kg/m，p=0.007）。LTI 与主观整体评估（SGA）之间的一致性kappa 系数为 0.26，表明存在营养不良。在平均 26.7 个月的观察期间，123 名患者中有 20 名（16.3%）死亡。在 Cox 回归分析中，低 LTI 对生存的预测仍然很高（危险比：3.24，95%置信区间 1.06-9.91，p=0.04）。SGA 定义的营养不良在 Kaplan-Meier 分析中预测生存（对数秩 χ=4.05；p=0.04），但在多变量分析中则不然。
LTI 是死亡率的预测指标，当将 FTI、SGA 和水合状态纳入多变量分析时，其预测能力不受影响。然而，SGA 可能不足以识别中国血液透析患者中死亡风险较高的患者。
