Predicting Clinical Outcomes using Phase Angle as Assessed by Bioelectrical Impedance Analysis in Maintenance Hemodialysis Patients
Abstract Objective Protein-energy wasting is common in hemodialysis patients and is an independent risk factor for adverse events. We retrospectively investigated whether phase angle (PA), known as a nutritional marker, can predict various clinical outcomes in end-stage renal disease (ESRD) patients...
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| Veröffentlicht in: | Nutrition (Burbank, Los Angeles County, Calif.) Los Angeles County, Calif.), 2017-09, Vol.41, p.7-13 |
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| creator | Shin, Jung-ho Kim, Chae Rim Park, Ki Hyun Hwang, Jin Ho Kim, Su Hyun |
| description | Abstract Objective Protein-energy wasting is common in hemodialysis patients and is an independent risk factor for adverse events. We retrospectively investigated whether phase angle (PA), known as a nutritional marker, can predict various clinical outcomes in end-stage renal disease (ESRD) patients receiving hemodialysis. Methods Using bioelectrical impedance analysis (BIA), PA was obtained every 6 months, and patients were divided into two groups according to baseline PA: group A included patients with PA ≥4.5°, while group B included patients with PA |
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We retrospectively investigated whether phase angle (PA), known as a nutritional marker, can predict various clinical outcomes in end-stage renal disease (ESRD) patients receiving hemodialysis. Methods Using bioelectrical impedance analysis (BIA), PA was obtained every 6 months, and patients were divided into two groups according to baseline PA: group A included patients with PA ≥4.5°, while group B included patients with PA <4.5 Results A total of 142 patients were followed-up for the median of 29 (12, 42) months. We found that a decrease in PA was associated with an increased risk of death that persisted after adjusting for age, sex, and comorbidities (HR 0.56, 95% CI 0.33 – 0.97). Cardiovascular events were not associated with PA (P = 0.685). We found that PA predicted the occurrence of infection, independent of age, sex, and comorbidities (HR 0.65, 95% CI 0.45 – 0.94). Although levels of hemoglobin did not differ between groups during the study period, patients in group B received higher doses of erythropoiesis-stimulating agents and intravenous iron than those in group A (P = 0.004 and 0.044, respectively). In longitudinal analyses, we did not find increases in PA over time in patients who had a mean Kt/Vurea ≥1.4, protein catabolic rate ≥1.2 g/kg/day, or total CO2 level ≥22 mmol/L. Conclusions PA assessed in a simple manner using BIA provides practical information to predict clinical outcomes in ESRD patients on maintenance hemodialysis.</description><identifier>ISSN: 0899-9007</identifier><identifier>EISSN: 1873-1244</identifier><identifier>DOI: 10.1016/j.nut.2017.02.013</identifier><identifier>PMID: 28760431</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute coronary syndromes ; Adequacy ; Age ; Aged ; Anemia ; Bioelectrical impedance analysis ; Bioelectricity ; Body composition ; Carbon dioxide ; Cardiovascular Diseases - epidemiology ; Clinical outcomes ; Comorbidity ; Confidence intervals ; Death ; Dialysis ; Electric Impedance ; End-stage renal disease ; Erythropoiesis ; Female ; Follow-Up Studies ; Gastroenterology and Hepatology ; Heart failure ; Hemodialysis ; Hemoglobin ; Hospitalization ; Humans ; Impedance ; Infection - epidemiology ; Infections ; Information dissemination ; Intravenous administration ; Iron ; Kidney diseases ; Kidney Failure, Chronic - epidemiology ; Kidney Failure, Chronic - therapy ; Kidney transplantation ; Korea - epidemiology ; Laboratories ; Male ; Malnutrition ; Middle Aged ; Mortality ; Nutrition ; Nutritional Status ; Outcomes ; Patient Outcome Assessment ; Patients ; Phase angle ; Predictive Value of Tests ; Proteins ; Renal Dialysis ; Retrospective Studies ; Risk factors ; Sex ; Sex ratio</subject><ispartof>Nutrition (Burbank, Los Angeles County, Calif.), 2017-09, Vol.41, p.7-13</ispartof><rights>Elsevier Inc.</rights><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Science Ltd. Sep 1, 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c502t-dae5dcf7db2fc3bfc5da96ad1c860a0403030c4a50ee0f92aebb919aa9ba48d63</citedby><cites>FETCH-LOGICAL-c502t-dae5dcf7db2fc3bfc5da96ad1c860a0403030c4a50ee0f92aebb919aa9ba48d63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1925903240?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28760431$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shin, Jung-ho</creatorcontrib><creatorcontrib>Kim, Chae Rim</creatorcontrib><creatorcontrib>Park, Ki Hyun</creatorcontrib><creatorcontrib>Hwang, Jin Ho</creatorcontrib><creatorcontrib>Kim, Su Hyun</creatorcontrib><title>Predicting Clinical Outcomes using Phase Angle as Assessed by Bioelectrical Impedance Analysis in Maintenance Hemodialysis Patients</title><title>Nutrition (Burbank, Los Angeles County, Calif.)</title><addtitle>Nutrition</addtitle><description>Abstract Objective Protein-energy wasting is common in hemodialysis patients and is an independent risk factor for adverse events. We retrospectively investigated whether phase angle (PA), known as a nutritional marker, can predict various clinical outcomes in end-stage renal disease (ESRD) patients receiving hemodialysis. Methods Using bioelectrical impedance analysis (BIA), PA was obtained every 6 months, and patients were divided into two groups according to baseline PA: group A included patients with PA ≥4.5°, while group B included patients with PA <4.5 Results A total of 142 patients were followed-up for the median of 29 (12, 42) months. We found that a decrease in PA was associated with an increased risk of death that persisted after adjusting for age, sex, and comorbidities (HR 0.56, 95% CI 0.33 – 0.97). Cardiovascular events were not associated with PA (P = 0.685). We found that PA predicted the occurrence of infection, independent of age, sex, and comorbidities (HR 0.65, 95% CI 0.45 – 0.94). Although levels of hemoglobin did not differ between groups during the study period, patients in group B received higher doses of erythropoiesis-stimulating agents and intravenous iron than those in group A (P = 0.004 and 0.044, respectively). In longitudinal analyses, we did not find increases in PA over time in patients who had a mean Kt/Vurea ≥1.4, protein catabolic rate ≥1.2 g/kg/day, or total CO2 level ≥22 mmol/L. Conclusions PA assessed in a simple manner using BIA provides practical information to predict clinical outcomes in ESRD patients on maintenance hemodialysis.</description><subject>Acute coronary syndromes</subject><subject>Adequacy</subject><subject>Age</subject><subject>Aged</subject><subject>Anemia</subject><subject>Bioelectrical impedance analysis</subject><subject>Bioelectricity</subject><subject>Body composition</subject><subject>Carbon dioxide</subject><subject>Cardiovascular Diseases - epidemiology</subject><subject>Clinical outcomes</subject><subject>Comorbidity</subject><subject>Confidence intervals</subject><subject>Death</subject><subject>Dialysis</subject><subject>Electric Impedance</subject><subject>End-stage renal disease</subject><subject>Erythropoiesis</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastroenterology and Hepatology</subject><subject>Heart failure</subject><subject>Hemodialysis</subject><subject>Hemoglobin</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Impedance</subject><subject>Infection - epidemiology</subject><subject>Infections</subject><subject>Information dissemination</subject><subject>Intravenous administration</subject><subject>Iron</subject><subject>Kidney diseases</subject><subject>Kidney Failure, Chronic - epidemiology</subject><subject>Kidney Failure, Chronic - therapy</subject><subject>Kidney transplantation</subject><subject>Korea - epidemiology</subject><subject>Laboratories</subject><subject>Male</subject><subject>Malnutrition</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Nutrition</subject><subject>Nutritional Status</subject><subject>Outcomes</subject><subject>Patient Outcome Assessment</subject><subject>Patients</subject><subject>Phase angle</subject><subject>Predictive Value of Tests</subject><subject>Proteins</subject><subject>Renal Dialysis</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Sex</subject><subject>Sex ratio</subject><issn>0899-9007</issn><issn>1873-1244</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kk2LFDEQhoMo7jj6A7xIwIuXbivpzyAI46DuwsoOqOeQTqrXjP0xprqFOfvHTe-MCnuQBAKV962i6inGngtIBYjy9T4d5imVIKoUZAoie8BWoq6yRMg8f8hWUCuVKIDqgj0h2gOAUKV6zC5kXZWQZ2LFfu0COm8nP9zybecHb03Hb-bJjj0Sn2mJ774ZQr4ZbjvkhviGCON1vDnyd37EDu0U7nxX_QGdGewiNt2RPHE_8E_GDxMOd_FL7Efnz387M3kcJnrKHrWmI3x2ftfs64f3X7aXyfXNx6vt5jqxBcgpcQYLZ9vKNbK1WdPawhlVGidsXYKBHLJ4bG4KQIRWSYNNo4QyRjUmr12ZrdmrU95DGH_MSJPuPVnsOjPgOJMWShayysqqitKX96T7cQ6xqZNKQSZjvTUTJ5UNI1HAVh-C7004agF6IaT3OhLSCyENUkdC0fPinHluenR_HX-QRMGbkwDjKH56DJpsHJONmEKctHaj_2_6t_fc9kz1Ox6R_nWhKRr052VFlg0RVQZQxvK_AY-9uIE</recordid><startdate>20170901</startdate><enddate>20170901</enddate><creator>Shin, Jung-ho</creator><creator>Kim, Chae Rim</creator><creator>Park, Ki Hyun</creator><creator>Hwang, Jin Ho</creator><creator>Kim, Su Hyun</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RQ</scope><scope>7RV</scope><scope>7TS</scope><scope>7U7</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20170901</creationdate><title>Predicting Clinical Outcomes using Phase Angle as Assessed by Bioelectrical Impedance Analysis in Maintenance Hemodialysis Patients</title><author>Shin, Jung-ho ; Kim, Chae Rim ; Park, Ki Hyun ; Hwang, Jin Ho ; Kim, Su Hyun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c502t-dae5dcf7db2fc3bfc5da96ad1c860a0403030c4a50ee0f92aebb919aa9ba48d63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acute coronary syndromes</topic><topic>Adequacy</topic><topic>Age</topic><topic>Aged</topic><topic>Anemia</topic><topic>Bioelectrical impedance analysis</topic><topic>Bioelectricity</topic><topic>Body composition</topic><topic>Carbon dioxide</topic><topic>Cardiovascular Diseases - epidemiology</topic><topic>Clinical outcomes</topic><topic>Comorbidity</topic><topic>Confidence intervals</topic><topic>Death</topic><topic>Dialysis</topic><topic>Electric Impedance</topic><topic>End-stage renal disease</topic><topic>Erythropoiesis</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastroenterology and Hepatology</topic><topic>Heart failure</topic><topic>Hemodialysis</topic><topic>Hemoglobin</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Impedance</topic><topic>Infection - epidemiology</topic><topic>Infections</topic><topic>Information dissemination</topic><topic>Intravenous administration</topic><topic>Iron</topic><topic>Kidney diseases</topic><topic>Kidney Failure, Chronic - epidemiology</topic><topic>Kidney Failure, Chronic - therapy</topic><topic>Kidney transplantation</topic><topic>Korea - epidemiology</topic><topic>Laboratories</topic><topic>Male</topic><topic>Malnutrition</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Nutrition</topic><topic>Nutritional Status</topic><topic>Outcomes</topic><topic>Patient Outcome Assessment</topic><topic>Patients</topic><topic>Phase angle</topic><topic>Predictive Value of Tests</topic><topic>Proteins</topic><topic>Renal Dialysis</topic><topic>Retrospective Studies</topic><topic>Risk factors</topic><topic>Sex</topic><topic>Sex ratio</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shin, Jung-ho</creatorcontrib><creatorcontrib>Kim, Chae Rim</creatorcontrib><creatorcontrib>Park, Ki Hyun</creatorcontrib><creatorcontrib>Hwang, Jin Ho</creatorcontrib><creatorcontrib>Kim, Su Hyun</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Career & Technical Education Database</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Toxicology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Nutrition (Burbank, Los Angeles County, Calif.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shin, Jung-ho</au><au>Kim, Chae Rim</au><au>Park, Ki Hyun</au><au>Hwang, Jin Ho</au><au>Kim, Su Hyun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predicting Clinical Outcomes using Phase Angle as Assessed by Bioelectrical Impedance Analysis in Maintenance Hemodialysis Patients</atitle><jtitle>Nutrition (Burbank, Los Angeles County, Calif.)</jtitle><addtitle>Nutrition</addtitle><date>2017-09-01</date><risdate>2017</risdate><volume>41</volume><spage>7</spage><epage>13</epage><pages>7-13</pages><issn>0899-9007</issn><eissn>1873-1244</eissn><abstract>Abstract Objective Protein-energy wasting is common in hemodialysis patients and is an independent risk factor for adverse events. We retrospectively investigated whether phase angle (PA), known as a nutritional marker, can predict various clinical outcomes in end-stage renal disease (ESRD) patients receiving hemodialysis. Methods Using bioelectrical impedance analysis (BIA), PA was obtained every 6 months, and patients were divided into two groups according to baseline PA: group A included patients with PA ≥4.5°, while group B included patients with PA <4.5 Results A total of 142 patients were followed-up for the median of 29 (12, 42) months. We found that a decrease in PA was associated with an increased risk of death that persisted after adjusting for age, sex, and comorbidities (HR 0.56, 95% CI 0.33 – 0.97). Cardiovascular events were not associated with PA (P = 0.685). We found that PA predicted the occurrence of infection, independent of age, sex, and comorbidities (HR 0.65, 95% CI 0.45 – 0.94). Although levels of hemoglobin did not differ between groups during the study period, patients in group B received higher doses of erythropoiesis-stimulating agents and intravenous iron than those in group A (P = 0.004 and 0.044, respectively). In longitudinal analyses, we did not find increases in PA over time in patients who had a mean Kt/Vurea ≥1.4, protein catabolic rate ≥1.2 g/kg/day, or total CO2 level ≥22 mmol/L. Conclusions PA assessed in a simple manner using BIA provides practical information to predict clinical outcomes in ESRD patients on maintenance hemodialysis.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28760431</pmid><doi>10.1016/j.nut.2017.02.013</doi><tpages>7</tpages></addata></record> |
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| subjects | Acute coronary syndromes Adequacy Age Aged Anemia Bioelectrical impedance analysis Bioelectricity Body composition Carbon dioxide Cardiovascular Diseases - epidemiology Clinical outcomes Comorbidity Confidence intervals Death Dialysis Electric Impedance End-stage renal disease Erythropoiesis Female Follow-Up Studies Gastroenterology and Hepatology Heart failure Hemodialysis Hemoglobin Hospitalization Humans Impedance Infection - epidemiology Infections Information dissemination Intravenous administration Iron Kidney diseases Kidney Failure, Chronic - epidemiology Kidney Failure, Chronic - therapy Kidney transplantation Korea - epidemiology Laboratories Male Malnutrition Middle Aged Mortality Nutrition Nutritional Status Outcomes Patient Outcome Assessment Patients Phase angle Predictive Value of Tests Proteins Renal Dialysis Retrospective Studies Risk factors Sex Sex ratio |
| title | Predicting Clinical Outcomes using Phase Angle as Assessed by Bioelectrical Impedance Analysis in Maintenance Hemodialysis Patients |
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