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Association analysis of body composition with survival among prevalent peritoneal dialysis patients

  • Nephrology - Original Paper
  • Published:
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Abstract

Purpose

Progressive decline in lean mass and gain of fat mass are common in patients treated with peritoneal dialysis (PD). It is unclear whether body composition or its longitudinal changes contribute to increased mortality among prevalent PD patients.

Methods

This was a retrospective cohort study. Body composition was assessed using bioelectrical impedance spectroscopy (BIS). Lean and fat tissue indices were derived from lean and fat mass indexed to height-squared, respectively. The patient’s baseline BIS results were used to explore its mortality risk prediction for the entire cohort. Among patients with subsequent BIS measurements, changes of lean and fat mass over time were also examined with survival outcomes.

Results

Among all participants (n = 555, PD vintage 38 months), higher baseline lean tissue index was associated with lower mortality after adjusting for fat tissue index and confounders (HR 0.90; 95% CI 0.84–0.97, p = 0.01). However, this association was no longer significance after the final adjustment with serum albumin level (p = 0.06). A total of 136 patients had repeated BIS data. After the interval of 10.1 months during two consecutive BIS measurements, there was a strong inverse correlation between the percentage changes of lean and fat tissue indices (r = − 0.73, p < 0.001). The longitudinal changes in lean mass, either high or low categories, were not significantly associated with all-cause mortality. In contrast, patients who were classified as having low values of fat tissue index (below median) from baseline to the next BIS measurements had a lower odds of death in the univariable (HR 0.32; 95% CI 0.12–0.84, p = 0.02) but not in the adjusted models.

Conclusion

Among prevalent PD patients, higher baseline lean mass was independently associated with better survival. However, the longitudinal changes in lean mass were not significantly associated with mortality. In contrast, the maintenance of low fat status over time appeared to be associated with a lower likelihood of death among PD population.

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Funding

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Authors and Affiliations

  1. Division of Internal Medicine-Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

    Piyawan Kittiskulnam

  2. Special Task Force for Activating Research in Renal Nutrition (Renal Nutrition Research Group), Office of Research Affairs, Chulalongkorn University, Bangkok, Thailand

    Piyawan Kittiskulnam, Kearkiat Praditpornsilpa & Somchai Eiam-Ong

  3. Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Piyawan Kittiskulnam, Kearkiat Praditpornsilpa, Kriang Tungsanga, Somchai Eiam-Ong & Talerngsak Kanjanabuch

  4. Banphaeo-Charoenkrung Peritoneal Dialysis Center, Banphaeo Dialysis Group, Banphaeo Hospital, Bangkok, 10330, Thailand

    Piyatida Chuengsaman & Sirarat Katesomboon

  5. Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Talerngsak Kanjanabuch

Authors
  1. Piyawan Kittiskulnam
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  2. Piyatida Chuengsaman
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  3. Sirarat Katesomboon
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  4. Kearkiat Praditpornsilpa
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  7. Talerngsak Kanjanabuch
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Contributions

Conceptualization: PK; data curation: TK, PC, and SK; formal analysis and interpretation: PK, KP, KT, and TK; writing original draft and editing: PK; supervision and mentorship: SE. Each author contributed important intellectual content during manuscript drafting. All the authors made substantial contributions, read, and approved the final manuscript.

Corresponding author

Correspondence to Talerngsak Kanjanabuch.

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Conflict of interests

This work has been made possible in part by a Special Task Force for Activating Research (STAR) in Renal Nutrition, Chulalongkorn University funded grant to Dr. Kittiskulnam. Dr. Kanjanabuch reports grants from National Research Council of Thailand, grants from Rachadaphiseksompot Endorsement Fund, Chulalongkorn University, grants from Thailand Research Foundation, outside the submitted work and receiving consultancy fees from VISTERRA as a country investigator and speaking honoraria from Astra Zeneca and Baxter Healthcare. All the authors declare no conflict of interests.

Ethical approval

This study was performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards (IRB No. 406/63). This article does not contain any data obtained directly from human (only document extraction) and there were no additional clinical and laboratory studies in the included patients. Informed consent was not obtained in the study.

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Kittiskulnam, P., Chuengsaman, P., Katesomboon, S. et al. Association analysis of body composition with survival among prevalent peritoneal dialysis patients. Int Urol Nephrol 54, 437–446 (2022). https://doi.org/10.1007/s11255-021-02923-6

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  • DOI: https://doi.org/10.1007/s11255-021-02923-6

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