Body composition monitoring and nutrition in maintenance hemodialysis and CAPD patients—a multicenter longitudinal study

Figures & data

Figure 1. Flowchart showing outcomes of the recruited patients at follow-up.

Figure 2. ROC curve between overhydration and mortality. Note: Area under the curve >50%, estimated cut off = 3.15 L, sensitivity = 39.47%, specificity = 69.70%.

Figure 3. ROC curve between body mass index and mortality. Note: Area under the curve >50%, estimated cut off = 22.65 kg/m², sensitivity = 41.30%, specificity = 81.81%.

Table 1. Baseline characteristics of MHD and CAPD patients.

Variables*	All patients (n = 99)	Survived (n = 41)	Died (n = 33)	p Value for comparison between survived and died
Age (years)	55.26 ± 12.5	52.20 ± 13.1	54.76 ± 7.6	0.32
Gender
Males (%)	78 (78.79%)	31 (75.6%)	26 (78.8%)	0.75
Females (%)	21	10	7
Weight (kg)	59.05 ± 12.6	56.52 ± 12.6	54.55 ± 9.6	0.46
Height (cm)	152.83 ± 9.0	160.61 ± 8.9	162.82 ± 9.5	0.31
BMI (kg/m^2)	22.23 ± 4.2	22.68 ± 4.2	20.53 ± 3.1	0.017
Mode of dialysis
MHD (%)	85 (86.14%)	33 (80.5%)	27 (81.8%)	0.89
CAPD (%)	14 (13.86%)	8 (19.5%)	6 (18.2%)
Diabetic (%)	39 (39.4%)	15(36.6%)	15 (45.5%)	0.44
Systolic BP (mmHg)	147.45 ± 21.8	147.49 ± 23.4	150.21 ± 21.2	0.61
Diastolic BP (mmHg)	83.55 ± 12.2	82.76 ± 12.1	84.48 ± 11.4	0.53
Urine output (mL)	100 (0–500)*	312.20 ± 386.6	180 (0–700)	0.48
Dry weight (kg)	56.00 ± 12.3	55.77 ± 12.7	51.78 ± 9.2	0.13
Diet
Vegetarian (%)	22 (22.22%)	13 (31.7%)	6 (18.2%)	0.186
Non-vegetarian (%)	77	28	27
TSF (cm)	6 (4–8)*	6 (4–8)*	6 (3–8)	0.42
BSF (cm)	4 (2–8)*	4 (2–6)*	4 (2–6)	0.87
MAC (cm)	16 (10–23)*	16.38 ± 7	17.29 ± 6.9	0.62
Serum albumin (g/dL)	3.6 ± 0.6	3.52 ± 0.5	3.52 ± 0.5	1
Haemoglobin (g/dL)	8.88 ± 1.8	8.9 ± 2	8.66 ± 1.6	0.58
S.Potassium (mEq/L)	4.76 ± 1.04	4.80 ± 1.1	4.68 ± 0.9	0.62
Urea (mg/dL)	83 (6–100)*	81.80 ± 29.3	81.39 ± 28.8	0.95
Creatinine (mg/dL)	6.8 ± 3.2	7.23 ± 3.0	6.28 ± 3.0	0.18
eGFR	12.1 ± 11.59	11.78 ± 13.43	12.49 ± 8.98	0.8
BCM parameters
Overhydration (L)	3.1 (1.85–4.30)*	2.90 (1.50–4.05)*	3.9 (2.65–4.80)*	0.02
TBW (L)	29.41 ± 7.1	28.23 ± 6.9	28.55 ± 6.5	0.84
ECW (L)	14.91 ± 3.1	14.42 ± 3.3	15.03 ± 3.4	0.52
ICW (L)	14.40 ± 4.0	13.85 ± 3.9	13.62 ± 3.5	0.79
LTI (kg/m^2)	10.52 ± 2.8	10.48 ± 3.0	10.01 ± 2.3	0.46
FTI (kg/m^2)	10.45 ± 4.6	10.87 ± 4.3	9.07 ± 4.1	0.07
LTM (kg)	28.30 ± 9.2	27.49 ± 9.7	27.01 ± 8.3	0.82
Fat (kg)	20.09 ± 8.5	20.31 ± 7.8	17.45 ± 7.3	0.11
Relative fat (kg)	33.55 ± 10.8	34.65 ± 11	31.50 ± 10.7	0.22
ATM (kg)	27.33 ± 11.5	27.64 ± 10.6	23.74 ± 9.9	0.11
BCM (kg)	14.39 ± 6.1	14.00 ± 6.5	13.43 ± 5.3	0.69

Notes: MHD: Hemodialysis, CAPD: continuous ambulatory peritoneal dialysis, BMI: body mass index, TBW: total body water, ECW: extracellular water, ICW: intracellular water, LTI: lean tissue index, FTI: fat tissue index, LTM: lean tissue mass, ATM: adipose tissue mass, BCM: body cell mass, TSF: triceps skin fold, BSF: biceps skin fold, MAC: mid arm circumference.

*Median (IQR) for all continuous variables, comparison by Mann–Whitney U test; percentages for categorical variables, comparison by Chi square test.

Table 2. Comparison of body composition and nutritional parameters of survived MHD and CAPD patients between baseline and follow-up.

	At baseline (n = 41)		At follow-up (n = 41)
Variables	Mean (SD)	Median (IQR)	Mean (SD)	Median (IQR)	p Value
TBW (L)	28.23 ± 6.91	28.3 (22.9–34.1)	29.94 ± 8.1	27.60 (19.9–53.4)	0.140
ECW (L)	14.42 ± 3.33	14.3 (11.8–17.0)	13.88 ± 2.8	13.3 (9.7–20.8)	0.171
ICW (L)	13.86 ± 3.97	13 (10.4–7.15)	16.03 ± 6.4	13.9 (10.1–37.4)	0.022*
LTI (kg/m^2)	10.28 ± 3.07	10.1 (8.2–12.3)	10.95 ± 3.0	10.4 (7–19)	0.188
FTI (kg/m^2)	11.63 ± 3.76	11.8 (7.2–13.8)	12.18 ± 5.8	12.7 (3–26)	0.730
LTM (kg)	26.54 ± 9.71	27.0 (19.4–37.4)	27.97 ± 8.7	25.2 (17–55)	0.302
Fat (kg)	21.60 ± 6.99	22.2 (13.60–26.1)	22.42 ± 11.8	22.5 (6–43)	0.839
Relative fat (%)	36.68 ± 9.40	36 (29.9–44.4)	35.96 ± 11.8	37.4 (11–54)	0.544
ATM (kg)	29.40 ± 9.49	30.3 (18.5–35.5)	30.77 ± 14.2	30.9 (7–58)	0.726
BCM (kg)	13.44 ± 6.48	12.8 (9–19.3)	14.48 ± 6.0	13.00 (7–33)	0.277
OH (L)	2.73 ± 1.87	2.9 (1.5–4.1)	0.95 ± 2.61	1.40 (−0.2–2.2)	<0.001*
TSF (cm)	6.66 ± 3.81	6 (4–8)	10 (6–25)	14.66 ± 9.48	<0.001*
BSF (cm)	5.23 ± 4.36	4 (2–6)	10 (4–22)	12.54 ± 10.13	<0.001*
MAC (cm)	16.38 ± 7.03	12 (11–23)	22.15 ± 6.4	23.00	<0.001*
S.albumin (gm/dL)	3.52 ± 0.50	3.65 (3.12–3.9)	3.44 ± 0.5	3.4	0.905
Hb (gm/dL)	8.94 ± 2.03	8.3 (7.6–10.6)	8.88 ± 1.6	8.8	0.877

Notes: MHD: hemodialysis, CAPD: continuous ambulatory peritoneal dialysis, TBW: total body water, ECW: extracellular water, ICW: intracellular water, LTI: lean tissue index, FTI: fat tissue index, LTM: lean tissue mass, ATM: adipose tissue mass, BCM: body cell mass, OH: overhydration, TSF: triceps skin fold, BSF: biceps skin fold, MAC: mid arm circumference.

*<0.05 significant.

Table 3. Comparison of demography, body composition and nutrition parameters at baseline for MHD and CAPD patients.

Variables*	MHD (n = 85)	CAPD (n = 14)	p Value
Age (years)	50.65 ± 12.23	60.43 ± 12.15	0.007
Gender
Males (%)	68 (80.0%)	10 (73.3%)	0.51
Females (%)	17 (20.0%)	4 (26.7%)
Weight (kg)	58.75 ± 13.02	60.89 ± 10.48	0.56
Height (cm)	163.58 ± 8.90	158.29 ± 8.82	0.04
BMI (kg/m^2)	21.90 ± 4.30	24.24 ± 3.18	0.05
Diabetic (%)	31 (36.5%)	8 (57.14)	0.26
Systolic BP (mmHg)	147.73 ± 21.32	145.79 ± 25.50	0.76
Diastolic BP (mmHg)	84.67 ± 12.23	76.71 ± 10.70	0.02
Urine output (mL)	100 (0–450)	200 (0–762)	0.32
Dry weight (kg)	55.71 ± 12.71	57.75 ± 10.34	0.57
Diet
Vegetarian	19 (22.4%)	4 (26.7%)	0.74
Non-vegetarian	66 (77.6%)	10 (73.3%)
TSF (cm)	6 (3–8)*	5.71 ± 2.09	0.92
BSF (cm)	4 (2–8)*	4 (2–5.25)*	0.48
MAC (cm)	16.12 ± 6.75	19.39 ± 6.92	0.10
S. albumin (gm/dL)	3.67 ± 0.66	3.31 ± 0.4	0.09
Haemoglobin (gm/dL)	8.75 ± 1.81	9.67 ± 1.80	0.09
S. Potassium (mEq/L)	4.86 ± 0.96	4.17 ± 1.33	0.02
Urea (mg/dL)	83 (64–102)*	62 (45.5–94.75)*	0.09
Creatinine (mg/dL)	6.77 ± 3.16	6.92 ± 3.45	0.87
Overhydration (L)	3.2 (2.0–4.4)*	2.75 (0.57–3.6)*	0.16
TBW (L)	29.75 ± 7.20)	27.36 ± 6.92	0.25
ECW (L)	15.16 ± 3.40	14.22 ± 3.38	0.34
ICW (L)	14.61 ± 4.13	13.14 ± 3.67	0.22
LTI (kg/m^2)	10.66 ± 2.79	9.71 ± 2.86	0.24
FTI (kg/m^2)	9.94 ± 4.60	13.41 ± 3.68	0.009
LTM (kg)	28.92 ± 9.19	24.74 ± 9.20	0.12
Relative LTM (%)	50.09 ± 13.85	40.25 ± 11.28	0.014
Fat (kg)	19.32 ± 8.62	24.74 ± 6.44	0.034
Relative fat (%)	32.34 ± 10.64	40.55 ± 9.19	0.008
ATM (kg)	26.28 ± 11.72	33.36 ± 8.7	0.034
BCM (kg)	14.76 ± 6.08	12.23 ± 6.13	0.16

Notes: MHD: hemodialysis, CAPD: continuous ambulatory peritoneal dialysis, BMI: body mass index, TBW: total body water, ECW: extracellular water, ICW: intracellular water, LTI: lean tissue index, FTI: fat tissue index, LTM: lean tissue mass, ATM: adipose tissue mass, BCM: body cell mass, TSF: triceps skin fold, BSF: biceps skin fold, MAC: mid arm circumference.

*Expressed as median (interquartile range).

Table 4. Comparison of body composition and nutritional parameters at 24 months for MHD and CAPD patients.

Variables*	MHD (n = 33)	CAPD (n = 8)	p Value
Weight (kg)	56.21 ± 11.87	61.36 ± 15.17	0.30
Height (cm)	161.42 ± 9.36	156.63 ± 7.09	0.18
BMI (kg/m^2)	21.45 ± 4.16	25.28 ± 4.01	0.024
Diabetic (%)	12 (36.5%)	5 (62.5%)	0.11
Systolic BP (mmHg)	157.36 ± 22.22	150.63 ± 25.31	0.46
Diastolic BP (mmHg)	87.67 ± 14.02	78.13 ± 16.64	0.10
Urine output (ml)	0 (0–400)	100 (0–287.50)	0.70
Dry weight (kg)	55.24 ± 13.42	59.62 ± 10.35	0.40
TSF (cm)	14 (8.50–26)	6 (6–8.75)	0.034
BSF (cm)	10 (5.50–24)	3.50 (2–5)	0.008
MAC (cm)	22.42 ± 6.34	21.06 ± 7.29	0.60
S. albumin (gm/dL)	3.48 ± 0.44	3.27 ± 0.71	0.30
Haemoglobin (gm/dL)	8.58 ± 1.51	10.12 ± 1.47	0.014
S. Potassium (mEq/L)	5.82 ± 0.80	4.20 (3.85–4.70)*	0.002
Urea (mg/dL)	108.27 ± 28.97	66.13 ± 25.50	0.001
Creatinine (mg/dL)	10.23 ± 2.79	7.93 ± 2.65	0.042
BCM parameters
Overhydration (L)	1.40 (0.2–2.4)*	1.45 (0.6–1.9)*	0.78
TBW (L)	30.53 ± 8.39	27.51 ± 6.85	0.35
ECW (L)	13.89 ± 3.71	13.85 ± 3.36	0.97
ICW (L)	16.60 ± 6.90	13.67 ± 3.48	0.25
LTI (kg/m^2)	11.30 ± 3.18	10.06 ± 2.27	0.36
FTI (kg/m^2)	11.20 (5.90–15)*	15.04 ± 1.78	0.028
LTM (kg)	28.73 ± 9.10	25.20 ± 7.34	0.32
Fat (kg)	21.70 (11.65–28.2)	27.51 ± 4.61	0.06
Relative fat (%)	33.97 ± 12.61	43.18 ± 3.28	0.051
ATM (kg)	29.80 (15.85–39.1)	37.45 ± 6.36	0.09
BCM (kg)	14.99 ± 6.27	12.64 ± 4.80	0.34

Notes: MHD: hemodialysis, CAPD: continuous ambulatory peritoneal dialysis, BMI: body mass index, TBW: total body water, ECW: extracellular water, ICW: intracellular water, LTI: lean tissue index, FTI: fat tissue index, LTM: lean tissue mass, ATM: adipose tissue mass, BCM: body cell mass, TSF: triceps skin fold, BSF: biceps skin fold, MAC: mid arm circumference.

*Expressed as Median (Interquartile range).

Table 5. Multiple logistic regressions for analyzing various predictors of mortality.

	Expired			95% for OR
Factors	n	Row%	Adj OR	LL	UL	p Value
BMI [kg/m^2]—at baseline
>Median (21.25)	11	29.7	1.00			Ref
≤Median (21.25)	22	59.5	2.352	0.768	7.203	0.134
Overhydration [L]—at baseline
≤Median (3.2)	11	28.9	1.00			Ref
>Median (3.2)	22	61.1	2.963	1.038	8.460	0.042
Fat tissue index [kg/m^2]—at baseline
>Median (10.2)	11	27.8	1.00			Ref
≤Median (10.2)	22	60.5	2.003	0.631	6.353	0.238