BACKGROUND: Lean body mass (LBM) is an important nutritional measure representing muscle mass and somatic protein in hemodialysis patients, for whom we developed and tested equations to estimate LBM. STUDY DESIGN: A study of diagnostic test accuracy. SETTING & PARTICIPANTS: The development cohort included 118 hemodialysis patients with LBM measured using dual-energy x-ray absorptiometry (DEXA) and near-infrared (NIR) interactance. The validation cohort included 612 additional hemodialysis patients with LBM measured using a portable NIR interactance technique during hemodialysis. INDEX TESTS: 3-month averaged serum concentrations of creatinine, albumin, and prealbumin; normalized protein nitrogen appearance; midarm muscle circumference (MAMC); handgrip strength; and subjective global assessment of nutrition. REFERENCE TEST: LBM measured using DEXA in the development cohort and NIR interactance in validation cohorts. RESULTS: In the development cohort, DEXA and NIR interactance correlated strongly (r = 0.94, P < 0.001). DEXA-measured LBM correlated with serum creatinine level, MAMC, and handgrip strength, but not with other nutritional markers. Three regression equations to estimate DEXA-measured LBM were developed based on each of these 3 surrogates and sex, height, weight, and age (and urea reduction ratio for the serum creatinine regression). In the validation cohort, the validity of the equations was tested against the NIR interactance-measured LBM. The equation estimates correlated well with NIR interactance-measured LBM (R² ≥ 0.88), although in higher LBM ranges, they tended to underestimate it. Median (95% confidence interval) differences and interquartile range for differences between equation estimates and NIR interactance-measured LBM were 3.4 (-3.2 to 12.0) and 3.0 (1.1-5.1) kg for serum creatinine and 4.0 (-2.6 to 13.6) and 3.7 (1.3-6.0) kg for MAMC, respectively. LIMITATIONS: DEXA measurements were obtained on a nondialysis day, whereas NIR interactance was performed during hemodialysis treatment, with the likelihood of confounding by volume status variations. CONCLUSIONS: Compared with reference measures of LBM, equations using serum creatinine level, MAMC, or handgrip strength and demographic variables can estimate LBM accurately in long-term hemodialysis patients.
BACKGROUND: Lean body mass (LBM) is an important nutritional measure representing muscle mass and somatic protein in hemodialysis patients, for whom we developed and tested equations to estimate LBM. STUDY DESIGN: A study of diagnostic test accuracy. SETTING & PARTICIPANTS: The development cohort included 118 hemodialysis patients with LBM measured using dual-energy x-ray absorptiometry (DEXA) and near-infrared (NIR) interactance. The validation cohort included 612 additional hemodialysis patients with LBM measured using a portable NIR interactance technique during hemodialysis. INDEX TESTS: 3-month averaged serum concentrations of creatinine, albumin, and prealbumin; normalized protein nitrogen appearance; midarm muscle circumference (MAMC); handgrip strength; and subjective global assessment of nutrition. REFERENCE TEST: LBM measured using DEXA in the development cohort and NIR interactance in validation cohorts. RESULTS: In the development cohort, DEXA and NIR interactance correlated strongly (r = 0.94, P < 0.001). DEXA-measured LBM correlated with serum creatinine level, MAMC, and handgrip strength, but not with other nutritional markers. Three regression equations to estimate DEXA-measured LBM were developed based on each of these 3 surrogates and sex, height, weight, and age (and urea reduction ratio for the serum creatinine regression). In the validation cohort, the validity of the equations was tested against the NIR interactance-measured LBM. The equation estimates correlated well with NIR interactance-measured LBM (R² ≥ 0.88), although in higher LBM ranges, they tended to underestimate it. Median (95% confidence interval) differences and interquartile range for differences between equation estimates and NIR interactance-measured LBM were 3.4 (-3.2 to 12.0) and 3.0 (1.1-5.1) kg for serum creatinine and 4.0 (-2.6 to 13.6) and 3.7 (1.3-6.0) kg for MAMC, respectively. LIMITATIONS: DEXA measurements were obtained on a nondialysis day, whereas NIR interactance was performed during hemodialysis treatment, with the likelihood of confounding by volume status variations. CONCLUSIONS: Compared with reference measures of LBM, equations using serum creatinine level, MAMC, or handgrip strength and demographic variables can estimate LBM accurately in long-term hemodialysis patients.
Authors: Kamyar Kalantar-Zadeh; Elani Streja; Csaba P Kovesdy; Antigone Oreopoulos; Nazanin Noori; Jennie Jing; Allen R Nissenson; Mahesh Krishnan; Joel D Kopple; Rajnish Mehrotra; Stefan D Anker Journal: Mayo Clin Proc Date: 2010-11 Impact factor: 7.616
Authors: W K Lo; B F Prowant; H L Moore; S B Gamboa; K D Nolph; M A Flynn; B Londeree; P Keshaviah; P Emerson Journal: Am J Kidney Dis Date: 1994-01 Impact factor: 8.860
Authors: Nazanin Noori; Csaba P Kovesdy; Ramanath Dukkipati; Usama Feroze; Miklos Z Molnar; Rachelle Bross; Allen R Nissenson; Joel D Kopple; Keith C Norris; Kamyar Kalantar-Zadeh Journal: Am J Nephrol Date: 2011-02-04 Impact factor: 3.754
Authors: Nazanin Noori; Andrew T Yan; Mercedeh Kiaii; Andrea Rathe; Marc B Goldstein; Olugbenga Bello; Ron Wald Journal: Int Urol Nephrol Date: 2017-04-29 Impact factor: 2.370
Authors: Jialin Wang; Elani Streja; Connie M Rhee; Melissa Soohoo; Mingliang Feng; Steven M Brunelli; Csaba P Kovesdy; Daniel Gillen; Kamyar Kalantar-Zadeh; Joline L T Chen Journal: J Ren Nutr Date: 2015-10-21 Impact factor: 3.655
Authors: I Rodríguez-Gómez; A Santalla; J Díez-Bermejo; D Munguía-Izquierdo; L M Alegre; G Nogales-Gadea; J Arenas; M A Martín; A Lucía; I Ara Journal: J Inherit Metab Dis Date: 2018-03-28 Impact factor: 4.982
Authors: Elani Streja; Miklos Z Molnar; Csaba P Kovesdy; Suphamai Bunnapradist; Jennie Jing; Allen R Nissenson; Istvan Mucsi; Gabriel M Danovitch; Kamyar Kalantar-Zadeh Journal: Clin J Am Soc Nephrol Date: 2011-03-17 Impact factor: 8.237