Association between Body Composition and Frailty among Prevalent Hemodialysis Patients: A US Renal Data System Special Study

• Published in: Journal of the American Society of Nephrology 2014-02, Vol.25 (2), p.381-389
• Main Authors: JOHANSEN, Kirsten L, DALRYMPLE, Lorien S, DELGADO, Cynthia, KAYSEN, George A, KORNAK, John, GRIMES, Barbara, CHERTOW, Glenn M
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Area Under Curve; Biological and medical sciences; Body Composition; Body Water; Clinical Research; Cross-Sectional Studies; Diabetes Mellitus - epidemiology; Electric Impedance; Emergency and intensive care: renal failure. Dialysis management; Fatigue - epidemiology; Female; Frail Elderly - statistics & numerical data; Gait; Hand Strength; Humans; Intensive care medicine; Male; Medical sciences; Middle Aged; Motor Activity; Muscle Weakness - epidemiology; Nephrology. Urinary tract diseases; Odds Ratio; Physical Endurance; Renal Dialysis - statistics & numerical data; ROC Curve; Sex Factors; United States - epidemiology; Weight Loss
• ISSN: 1046-6673; 1533-3450
• DOI: 10.1681/ASN.2013040431

Studies of frailty among patients on hemodialysis have relied on definitions that substitute self-reported functioning for measures of physical performance and omit weight loss or substitute alternate criteria. We examined the association between body composition and a definition of frailty that includes measured physical performance and weight loss in a cross-sectional analysis of 638 adult patients receiving maintenance hemodialysis at 14 centers. Frailty was defined as having three of following characteristics: weight loss, weakness, exhaustion, low physical activity, and slow gait speed. We performed logistic regression with body mass index (BMI) and bioelectrical impedance spectroscopy (BIS)-derived estimates of intracellular water (ICW), fat mass, and extracellular water (ECW) as the main predictors, and age, sex, race, and comorbidity as covariates. Overall, 30% of participants were frail. Older age (odds ratio [OR], 1.31 per 10 years; 95% confidence interval [95% CI], 1.14 to 1.50), diabetes (OR, 1.65; 95% CI, 1.13 to 2.40), higher fat mass (OR, 1.18; 95% CI, 1.02 to 1.37), and higher ECW (OR, 1.33; 95% CI, 1.20 to 1.47) associated with higher odds of frailty. Higher ICW associated with lower odds of frailty (OR, 0.80 per kg; 95% CI, 0.73 to 0.87). The addition of BMI data did not change the area under the receiver operating characteristics curve (AUC; AUC=0.66 versus 0.66; P=0.71), but the addition of BIS data did change the AUC (AUC=0.72; P