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PLoS One. 2019;14(4):e0214912.

Bioelectrical impedance analysis as a nutritional assessment tool in Autosomal Dominant Polycystic Kidney Disease.

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제1저자 류현진 · 교신저자 오국환, 안규리

PMID 30947248 PMC6449065 DOI 10.1371/journal.pone.0214912 IF 2.8 신장내과
소속 (9)
  1. Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
  2. Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea.
  3. Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea.
  4. National Assembly Futures Institute, Seoul, South Korea.
  5. Truewords Dialysis Clinic, Incheon, Korea.
  6. Department of Radiology, Seoul National University Hospital, Seoul, Korea.
  7. Department of Internal Medicine, Kangbuk Samsung Hospital, College of Medicine, Sungkyunkwan University, Seoul, Korea.
  8. Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
  9. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

Abstract

OBJECTIVE Autosomal dominant polycystic kidney disease (ADPKD) patients with massive organomegaly suffer from pressure-related complications including malnutrition. In this study, we analyzed the efficacy of segmental bioelectrical impedance analysis (BIA) for objective and quantitative nutritional assessment in ADPKD patients.

DESIGN AND METHODS We conducted a cross-sectional study, to evaluate the clinical utility of segmental BIA for assessing the nutritional status of ADPKD patients. BIA measurements was assessed according to modified subjective global assessment (SGA) scores and were compared with data from a healthy population. The association between BIA measurements and the height adjusted kidney and liver volumes (htTKLV), were analyzed.

SUBJECTS A total of 288 ADPKD patients, aged ≥ 18 years old, were analyzed.

MAIN OUTCOME MEASURES Nutritional status was evaluated with SGA and segmental BIA. The htTKLV were measured in each patients using computed tomonography images.

RESULTS Higher ratios of extracellular water to total body water (ECW/TBW) in the whole-body (ECW/TBWWB), trunk (ECW/TBWTR), and lower extremities (ECW/TBWLE) and lower phase angle of lower extremities (PhALE) correlated with lower SGA scores in the ADPKD population and in both gender. The four parameters, ECW/TBWWB, ECW/TBWTR, and ECW/TBWLE of >0.38 and PhALE of <5.8 θ were associated with malnutrition in ADPKD patients. These correlations were preserved in the subgroup analysis for chronic kidney disease stages 1-3A. Compared to healthy populations' data, body fluid parameters and segmental ECW/TBW values, except for the upper extremities (ECW/TBWUE), were greater in ADPKD patients. Increased htTKLV was an independent risk factor for malnutrition in ADPKD. The highest correlation with htTKLV was observed for the ECW/TBWTR (r = 0.466), followed by ECW/TBWWB (r = 0.407), ECW/TBWLE (r = 0.385), PhALE (r = -0.279), and PhATR (r = 0.215).

CONCLUSIONS These results demonstrated that segmental BIA parameters of ECW/TBWWB, ECW/TBWTR, ECW/TBWLE and PhALE provide useful information on nutritional status including the impact of organomegaly in ADPKD.

Figures

Fig 1
Fig 1 Associations of ECW/TBW and phase angle with SGA score. (A) ECW/TBWWB, (B) ECW/TBWTR, (C) ECW/TBWLE and (D) PhALE.ECW/TBWWB, TR and LE and PhALE associated with SGA scores in both genders. *P; P for trends, SGA 7, well-nourished; SGA 6, at risk; SGA 5, mildly malnourished; SGA 3–4, moderately malnourished, ECW/TBWWB; ratio of extracellular water to total body water of whole-body, ECW/TBWTR; ratio of extracellular water to total body water of trunk, ECW/TBWLE; ratio of extracellular water to total body water of lower extremities, PhALE; phase angle of lower extremities, SGA; subjective global assessment.
Fig 2
Fig 2 ROC curve of BIA parameters for the diagnosis of malnutrition and significant htTKLV. Predicting A) malnutrition defined as SGA score of 4 and 5 and B) significant htTKLV of ≥2,400 mL/m using BIA parameters. In the ROC curve analysis of BIA parameters to predict malnutrition, all AUCs were larger than 0.7 and the AUC for ECW/TBWWB was the largest (0.762). In the ROC curve analysis of BIA parameters to predict significant htTKLV values of ≥2,400 mL/m, all AUCs of parameters shown in the figure were larger than 0.6 and the AUC for ECW/TBWTR was the largest (0.726). AUC; area under curve, BIA; bioelectrical impedance analysis, ECW/TBWWB; ratio of extracellular water to total body water of whole-body, ECW/TBWTR; ratio of extracellular water to total body water of trunk, ECW/TBWLE; ratio of extracellular water to total body water of lower extremities, PhATR; Phase angle of trunk, PhALE; Phase angle of lower extremities, ROC; receiver-operating characteristics, SGA; subjective global assessment.
Fig 3
Fig 3 Likelihood (log odds) of having malnutrition (SGA 4&5 vs 7) with respect to various BIA parameters. A) ECW/TBWWB, (B) ECW/TBWTR, (C) ECW/TBWLE and (D) PhALE (θ). Log odds of having malnutrition increased as the ECW/TBW WB, TR and LE increased. On the contrary, log odds decreased with PhALE increased. BIA; bioelectrical impedance analysis, ECW/TBWWB; ratio of extracellular water to total body water of whole-body, ECW/TBWTR; ratio of extracellular water to total body water of trunk, ECW/TBWLE; ratio of extracellular water to total body water of lower extremities, PhALE; Phase angle of lower extremities, SGA; subjective global assessment.
Fig 4
Fig 4 Scatter plot and regression line of BIA parameters with ln htTKLV. Scatter plot of BIA parameters with ln htTKLV in total population and (B) in eGFR ≥45 mL/min/1.73 m2 patients. ECW/TBWWB, TR and,LE and PhATR showed positive correlation with ln htTKLV. On the contrary, PhALE showed negative correlation with ln htTKLV. ECW/TBW TR showed highest correlation with ln htTKLV (r = 0.466) BIA; bioelectrical impedance analysis, ECW/TBWWB; ratio of extracellular water to total body water of whole-body, ECW/TBWTR; ratio of extracellular water to total body water of trunk, ECW/TBWLE; ratio of extracellular water to total body water of lower extremities, eGFR; estimated glomerular filtration rates, ln htTKLV; natural log value of height-adjusted total kidney and liver volume, PhATR; Phase angle of trunk, PhALE; Phase angle of lower extremities.

그림 출처: PubMed Central 공개 논문 (PMC6449065)

Conflict of interest statement

The authors have declared that no competing interests exist.

그 밖의 정보
출판 형태
Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't
저널
PloS one · eISSN 1932-6203
전자 출판
2019-04-04
MeSH
Adult · Body Height* · Cross-Sectional Studies · Electric Impedance* · Female · Humans · Kidney / pathology · Liver / pathology · Male · Middle Aged · Nutrition Assessment* · Organ Size · Polycystic Kidney, Autosomal Dominant / pathology · Sex Factors
참고문헌
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