Department of Rehabilitation, Kisen Hospital, Tokyo, Japan.
Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.
Nephrology (Carlton). 2024 Oct;29(10):655-662. doi: 10.1111/nep.14333. Epub 2024 Jun 10.
Protein-energy wasting (PEW) is a common syndrome in patients undergoing haemodialysis (HD) and is associated with poor prognosis. Bioelectrical impedance analysis (BIA)-derived phase angle (PA) is useful for predicting PEW, but sex and age need to be considered. We aimed to reveal sex-specific cut-off values of PA predicting PEW in HD patients aged ≥65.
This two-centre retrospective cohort study included patients on HD who underwent BIA. PEW was detected using the International Society of Renal Nutrition and Metabolism (ISRNM) criteria as a reference. The PA was measured using a multifrequency bioimpedance device. Sex-specific cut-off values of PA predicting PEW were detected by receiver-operator characteristic analysis. We investigated the association between PEW determined using sex-specific cut-off values for PA and all-cause mortality.
This study included 274 patients undergoing HD, with a median age of 75 (70-80) years, mean PA of 3.8 ± 1.1° and PEW of 43%. Over a median follow-up duration of 1095 (400-1095) days, 111 patients died. Cut-off values of PA predicting PEW were as follows: female, 3.00° (sensitivity, 87.3%; specificity, 77.5%), and male, 3.84° (sensitivity, 77.6%; specificity, 71.4%). The kappa coefficient between sex-specific cut-off values of the PA and ISRNM criteria had a moderate coincidence level of 0.55. PEW detected by PA was independently associated with all-cause mortality (hazard ratio: 2.40; 95% confidence interval: 1.51-3.85; p < .001).
Sex-specific cut-off values for PA in older HD patients may be useful as a screening tool for predicting PEW and mortality.
蛋白能量消耗（PEW）是血液透析（HD）患者常见的综合征，与不良预后相关。生物电阻抗分析（BIA）衍生的相位角（PA）可用于预测 PEW，但需要考虑性别和年龄。我们旨在揭示年龄≥65 岁 HD 患者中 PA 预测 PEW 的性别特异性截断值。
这是一项两中心回顾性队列研究，纳入了接受 BIA 的 HD 患者。PEW 采用国际肾脏营养与代谢学会（ISRNM）标准作为参考进行检测。PA 使用多频生物阻抗设备进行测量。通过接受者操作特征分析检测预测 PEW 的 PA 的性别特异性截断值。我们研究了使用 PA 的性别特异性截断值确定的 PEW 与全因死亡率之间的关系。
本研究纳入了 274 名接受 HD 治疗的患者，中位年龄为 75（70-80）岁，平均 PA 为 3.8±1.1°，PEW 为 43%。在中位随访时间 1095（400-1095）天内，有 111 名患者死亡。预测 PEW 的 PA 截断值如下：女性为 3.00°（敏感性，87.3%；特异性，77.5%），男性为 3.84°（敏感性，77.6%；特异性，71.4%）。PA 的性别特异性截断值与 ISRNM 标准之间的 Kappa 系数具有中等一致性，为 0.55。PA 检测到的 PEW 与全因死亡率独立相关（危险比：2.40；95%置信区间：1.51-3.85；p<0.001）。
年龄≥65 岁的 HD 老年患者的 PA 性别特异性截断值可能是预测 PEW 和死亡率的有用筛查工具。
