Protein-energy-wasting and patient survival in maintenance peritoneal dialysis: Anthropometry or bioimpedance spectroscopy for the diagnosis? Results of a prospective multicenter study

Abstract

Background

Protein-energy-wasting (PEW) is a prevalent condition in patients undergoing peritoneal dialysis (PD) associated with poor outcomes and anthropometry assessment is necessary for its diagnosis. The aim of this study was to compare whether anthropometry or bioimpedance spectroscopy (BIS) in the diagnosis of PEW differ in predicting all-cause mortality in PD patients.

Methods

Prospective, multicenter and observational study. The diagnosis of PEW was performed using the criteria of the International Society of Renal Nutrition and Metabolism (ISRNM). The measurement of muscle and fat mass was done using both anthropometry and BIS. Patients were followed for up to two years for adverse events. The survival rates of the patients identified with PEW according to both methods were compared. Patient survival was analyzed using a competing risk approach as proposed by Fine and Gray.

Results

We included 121 patients with mean age of 58.9 ± 14.2 years, almost half of them with diabetes as the primary kidney disease (48.4%) and 52.5% were males. We identified 16 (13.2%) patients with PEW using anthropometry and 25 (20.7%) using BIS. In 92 (76%) patients there was no diagnosis of PEW independent of the method used to measure muscle mass and fat. PEW was a strong predictor of death. After adjustments for confounders the diagnosis of PEW using anthropometry was a better predictor of patient survival comparing to BIS.

Conclusion

PEW was associate with all-cause mortality either using anthropometry or BIS. Both assessment tools have clinical utility; however, in this study, anthropometry demonstrated greater effectiveness in identifying patients at increased risk of mortality.