Anthropometry and Body Composition in Chronic Kidney Disease Patients not on Dialysis

Chapter

Abstract

Chronic Kidney Disease (CKD), characterized by complex metabolic derangements is burdened by changes in nutritional status during the entire course of the disease. Overt malnutrition is usually observed in the late stages of CKD, but a decrease of body cell mass and other changes in body composition, for instance over-hydration, may occur early, even with no evidence of weight loss. The effects of alteration in nutritional status and body composition on clinical outcome are critical; protein-energy wasting by itself can worsen renal function and prognosis, being also strictly related to cardiovascular risk. On the other hand, some studies, but not all, have indicated that in CKD patients not yet on dialysis there is an inverse relationship between higher body mass index and some hard outcomes, such as mortality and cardiovascular events. In addition, body mass index seems to be a predictor of the onset of CKD in the general population; a possible association with waist circumference or waist-to-hip ratio has been described, as well. Thus, a challenge for nutritionists and nephrologists is to identify early changes of nutritional status in CKD patients in order to improve the patient’s prognosis. International guidelines advise to assess nutritional status on a regular basis, but indications for CKD patients not yet on dialysis have been much less defined than those for dialysis patients. In addition, assessment of nutritional status in CKD requires multiple measurements and different techniques should be used concurrently. Anthropometry represents a first level assessment tool with some limitations because of the possible influence of an over-hydration state; although not very sensitive in detecting minor changes in body composition, it remains useful if associated with other nutritional tools. Among these, bioimpedance analysis (BIA) should be considered because it is very easy to perform at the bedside and can detect changes of body fluids in the early stages of CKD, such as blunted over-hydration in absence of clinically detectable edema. Thus, anthropometry and BIA should be used concurrently in the evaluation of nutritional status in CKD patients.

Keywords

Cholesterol Obesity Hydration Filtration Albumin 

Abbreviations

BCM

Body cell mass

BIA

Bioimpedance analysis

BMI

Body mass index

CARI

Caring for Australian with Renal Impairment

CKD

Chronic kidney disease

CORR

Canadian Organ Replacement Registry

CT

Computed tomography

DXA

Dual X-ray absorptiometry

eGFR

Estimated GFR

ESRD

End stage renal disease

EURO-BPGL

European Best Practice Guidelines

FM

Fat mass

FFM

Free-fat mass

SFT

Skinfold thickness

GFR

Glomerular filtration rate

GH

Growth hormone

HR

Heart rate

KDIGO

Kidney Disease: Improving Global Outcomes

K/DOQI

Kidney/Disease Outcome Quality Initiative

MAC

Mid-arm circumference

MAMC

Mid-arm muscle circumference

PhA

Phase angle

PNAA

Prompt neutron activation analysis

PTH

Parathyroid hormone

R

Resistance

SGA

Subjective global assessment

TBW

Total body water

Xc

Reactance

WC

Waist circumference

WHO

World Health Organization

WHP

Waist-to-hip ratio

Notes

Acknowledgment

We are in debt to the table study group (Prof. G. Conte, Prof. L. De Nicola, and Prof. R. Minutolo; Nephrology Division, Department of Gerontology, Geriatrics and Metabolic Diseases, Second University of Naples, Naples, Italy) for providing us the database of CKD outpatients in the Italian tertiary nephrology care system which we used to obtain information on prevalence of overweight/obesity in chronic kidney disease.

References

  1. Avesani CM, Draibe SA, Kamimura MA, Cendoroglo M, Pedrosa A, Castro ML, Cuppari L. Nephrol Dial Transpl. 2004;19:2289–95CrossRefGoogle Scholar
  2. Barreto Silva MI, Avesani CM, Vale B, Lemos C, Bregman R. J Ren Nutr. 2008;18:355–62PubMedCrossRefGoogle Scholar
  3. Bellizzi V, Scalfi L, Terracciano V, De Nicola L, Minutolo R, Marra M, Guida B, Cianciaruso B, Conte G, Di Iorio B. J Am Soc Nephrol. 2006;17:1481–7PubMedCrossRefGoogle Scholar
  4. Chertow GM. J Ren Nutr. 1999;9: 138–41PubMedCrossRefGoogle Scholar
  5. De Nicola L, Minutolo R, Chiodini P, Zoccali C, Castellino P, Donadio C, Strippoli M, Casino F, Giannattasio M, Petrarulo F, Virgilio M, Laraia E, Di Iorio BR, Savica V, Conte G. Kidney Int. 2006;69(3)538–45CrossRefGoogle Scholar
  6. De Palo T, Messina G, Edefonti A, Perfumo F, Pisanello L, Peruzzi F, Di Iorio B, Mignozzi M, Vienna A, Conti G, Penza R, Piccoli A. Nutrition. 2000;16:417–24PubMedCrossRefGoogle Scholar
  7. Di Iorio B, Terracciano V, Bellizzi V. Nephron. 2000;86:531–3PubMedCrossRefGoogle Scholar
  8. Eckardt K-U, Berns JS, Rocco MV, Kasiske BL. Am J Kidney Dis. 2009;53(6):915–20.PubMedCrossRefGoogle Scholar
  9. Elsayed EF, Sarnak MJ, Tighiouart H, Griffith JL, Kurth T, Salem DN, Levey AS, Weiner DE. Am J Kidney Dis. 2008a;52:29–38PubMedCrossRefGoogle Scholar
  10. Elsayed EF, Tighiouart H, Weiner DE, Griffith J, Salem D, Levey AS, Sarnak MJ. Am J Kidney Dis. 2008b. 52:49–57PubMedCrossRefGoogle Scholar
  11. Foster MC, Hwang SJ, Larson MG, Lichtman JH, Parikh NI, Vasan RS, Levy D, Fox CS. Am J Kidney Dis. 2008;52:39–48PubMedCrossRefGoogle Scholar
  12. Fox CS, Larson MG, Leip EP, Culleton B, Wilson PW, Levy D. JAMA. 2004;291:844–50PubMedCrossRefGoogle Scholar
  13. Fouque D, Vennegoor M, Ter Wee P, Wanner C, Basci A, Canaud B, Haege K, Kooman J, Martin-Malo A, Pedrini L, Pizzarelli F, Tattersall J, Tordoir J, Vanholder R. Nephrol Dial Transpl. 2007;22(S2):45–87Google Scholar
  14. Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, Franch H, Guarnieri G, Ikizler TA, Kaysen G, Lindholm B, Massy Z, Mitch W, Pineda E, Stenvinkel P, Trevinho-Becerra A, Wanner C. Kidney Int. 2008;73: 391–8PubMedCrossRefGoogle Scholar
  15. Garg AX, Blake PG, Clark WF, Clase CM, Haynes RB, Moist LM. Kidney Int. 2001;60:1867–74.PubMedCrossRefGoogle Scholar
  16. Hsu CY, McCulloch CE, Iribarren C, Darbinian J, Go AS. Ann Intern Med. 2006;144:21–8PubMedGoogle Scholar
  17. Iseki K, Ikemiya Y, Kinjo K, Inoue T, Iseki C, Takishita S. Kidney Int. 2004;65:1870–6PubMedCrossRefGoogle Scholar
  18. K/DOQI. Am J Kidney Dis. 2000;35(S2):17–104Google Scholar
  19. K/DOQI. Am J Kidney Dis. 2009;(53-S3):1–123Google Scholar
  20. Kovesdy CP, Anderson JE, Kalantar-Zadeh K. Am J Kidney Dis. 2007;99:583–91Google Scholar
  21. Kovesdy CP, Kalantar-Zadeh K. Semin Nephrol. 2009;29:3–14PubMedCrossRefGoogle Scholar
  22. Kwan BC, Murtaugh MA, Beddhu S. Clin J Am Soc Nephrol. 2007;2:992–8.PubMedCrossRefGoogle Scholar
  23. Lin C-H, Chou C-Y, Lin C-C, Huang C-C, Liu C-S, Lai S-W. Nutrition. 2007;23:788–93PubMedCrossRefGoogle Scholar
  24. Madero M, Sarnak MJ, Wang X, Castaneda Sceppa C, Greene T, Beck GJ, Kusek JW, Collins AJ, Levey AS, Menon V. Am J Kidney Dis. 2007;50:404–11PubMedCrossRefGoogle Scholar
  25. Mafra D, Guebre-Egziabher F, Fouque D. Body mass index, muscle and fat in chronic kidney disease: Questions about survival. Nephrol Dial Transplant. 2008;23(8):2461–6Google Scholar
  26. Maggiore Q, Nigrelli S, Ciccarelli C, Grimaldi C, Rossi GA, Michelassi C. Kidney Int. 1996;50:2103–8PubMedCrossRefGoogle Scholar
  27. Munkhaugen J, Lydersen S, Widerøe TE, Hallan S. Am J Kidney Dis. 2009;54:638–46PubMedCrossRefGoogle Scholar
  28. No authors. In UK clinical practice guidelines, 4th edn. Module 2: complications. 2007. http://www.kdigo.org/guidelinescompare/uk.html
  29. Noori N, Hosseinpanah F, Nasiri AA, Azizi F. J Ren Nutr. 2009;19:228–37PubMedCrossRefGoogle Scholar
  30. Obermayr RP, Temml C, Knechtelsdorfer M, Gutjahr G, Kletzmayr J, Heiss S, Ponholzer A, Madersbacher S, Oberbauer R, Klauser-Braun R. Nephrol Dial Transpl. 2008;23:1265–73CrossRefGoogle Scholar
  31. Obermayr RP, Temml C, Gutjahr G, Kainz A, Klauser-Braun R, Függer R, Oberbauer R. Nephrol Dial Transpl. 2009;24:2421–8.CrossRefGoogle Scholar
  32. Piccoli A, Rossi B, Luana P, Bucciante G. Kidney Int. 1994;46:534–9PubMedCrossRefGoogle Scholar
  33. Pupin L, Martin CJ, Ikizler TA. In: Kopple JD, Massry SG, editors. Nutritional management of renal disease. Philadelphia: Lippincott Williams & Wilkins Publisher; 2004. p. 223–40.Google Scholar
  34. Sanches FM, Avesani CM, Kamimura MA, Lemos MM, Axelsson J, Vasselai P, Draibe SA, Cuppari L. Am J Kidney Dis. 2008;52:66–73PubMedCrossRefGoogle Scholar
  35. Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, McCullough PA, Kasiske BL, Kelepouris E, Klag MJ, Parfrey P, Pfeffer M, Raij L, Spinosa DJ, Wilson PW. Circulation 2003;108:2154–69.PubMedCrossRefGoogle Scholar
  36. Sawara Y, Takei T, Uchida K, Tsuchiya K, Nitta K. Heart Vessels. 2009;24:199–203PubMedCrossRefGoogle Scholar
  37. Velludo CM, Kamimura MA, Sanches FM, Lemos MM, Canziani ME, Pupim LB, Draibe SA, Cuppari L. Am J Nephrol. 2009;31:104–9.PubMedCrossRefGoogle Scholar
  38. Weiner DE, Tighiouart H, Elsayed EF, Griffith JL, Salem DN, Levey AS, Sarnak MJ. Am J Kidney Dis. 2008;51:212–23PubMedCrossRefGoogle Scholar
  39. Yamagata K, Ishida K, Sairenchi T, Takahashi H, Ohba S, Shiigai T, Narita M, Koyama A. Kidney Int. 2007;71:159–66PubMedCrossRefGoogle Scholar
  40. Zoccali C. Nephrol Dial Transpl. 2009;24:376–80CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Vincenzo Bellizzi
    • 1
  • Biagio Di Iorio
  • Luca Scalfi
  1. 1.Nephrology, Dialysis & Transplantation Unit, “San Giovanni di Dio e Ruggi d’Aragona”University Hospital, SalernoSalernoItaly

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