Low Muscle Mass is a Risk Factor of Mortality in Older Patients on Dialysis

Khor-Chyi Sheng ； Lin-Chien Lee ； Wei-Jie Wang ； Hung-Chieh Wu

《Acta Nephrologica》 31卷2期 (2017/06) Pp. 57-66

https://doi.org/10.6221/AN.2016019

摘要

BACKGROUND: This study examines the associations between low muscle mass, with or without overweight, and dialysis mortality. METHODS: Older patients who initiate hemodialysis in Taoyuan General Hospital from January 2012 to October 2016 were enrolled. We reviewed clinical characteristics, biochemical data at start of dialysis and followed over a 4-year period after dialysis. Body composition parameters were assessed 6 months to 1 year after dialysis. Patients with body mass index ＞ 25 kg/m^2 was defined as overweight. Lean tissue mass index (LTI) was defined by lean tissue mass divided by squared height (LTM/Ht^2). Low or high muscle mass were divided by median of LTI. Men with LTI ＜ 9.64 kg/m^2 and women with LTI ＜ 9.54 kg/ m^2 were regarded as low muscle mass. Hazard ratios (HRs) for mortality and cumulative survival curves were evaluated by Cox hazards model and Kaplan Meier method. The discriminative power of LTI was calculated according the area under the curve and the receiver operating characteristic curve (AUROC). RESULTS: From a total of 194 hemodialysis patients, the proportions of high muscle mass without overweight, high muscle mass with overweight, low muscle mass without overweight and low muscle mass with overweight were 23.5%, 26.8%, 26.8% and 22.7% respectively. After multivariate adjustment, low muscle mass, with or without overweight, at baseline was significant a predictor for dialysis mortality (HRs: 2.945 and 3.468). The discriminative power of LTI to predict survival was 0.626 (0.506 ~ 0.745) for men and 0.608 (0.499 ~ 0.717) for women (P = 0.042 and 0.060) with best cut-off value were 8.98 and 8.91 kg/m^2 CONCLUSION: Low muscle mass, with or without overweight, is a significant predictor of dialysis mortality, especially for older men.

關鍵字

body composition ； dialysis ； low muscle mass ； mortality ； overweight