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Alterations of body composition patterns in pre-dialysis chronic kidney disease patients

  • Nephrology - Original Paper
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Abstract

Purpose

Body mass index (BMI) might be an inaccurate estimate of detailed body composition because it does not differentiate muscle from fat mass. We sought to understand the effect of kidney function decline on alterations of body composition patterns among pre-dialysis CKD patients.

Methods

Body composition was measured by multi-frequency bioelectrical impedance analysis (BIA). Low muscle mass was defined as appendicular muscle mass (kg) adjusted to the square of height in meters < 7.0 and 5.7 kg/m2 in men and women, respectively. The designation of obesity by percent body fat was ≥ 25% in men and ≥ 30% in women. Alternative definition of obesity by BMI was ≥ 25 kg/m2. Visceral fat area cut point was > 100 cm2 as indication of abdominal obesity.

Results

Mean age of participants was 61.3 ± 13.8 years (n = 103). The average glomerular filtration rate (GFR) was 34.0 ± 24.2 mL/min/1.73 m2. By BIA, the prevalence of low muscle mass was 16.5% and was comparable between both sexes. Obesity by percent body fat was identified in 71.8% of patients and 38.2% had abdominal obesity. Using BMI criteria, the prevalence of obesity was less common (55.3%) and associated with under-identification of obesity by 27.0%. Low muscle mass and obesity by percent body fat were more prevalent in the more advanced stages of CKD. By multivariable regression analysis, a 10 mL/min/1.73 m2 decline in GFR was associated with a 0.59 kg reduction of total body muscle mass (p = 0.01), but not fat mass or BMI, after adjusting for confounders.

Conclusion

Low muscle mass was prevalent among pre-dialysis CKD patients. BMI commonly classified obese CKD individuals by percent body fat criteria as non-obese. The reduction of muscle mass was associated with GFR decline.

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Acknowledgements

We would like to thank Wasan Panyasang, M.Sc. (Applied statistics), as the consulting statistician for this project.

Funding

This work has been made possible in part by a Special Task Force for Activating Research (STAR) in Renal Nutrition, Chulalongkorn University funded grant to Dr. Kittiskulnam.

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Authors and Affiliations

  1. Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

    Piyawan Kittiskulnam, Mayura Nitesnoppakul, Suchai Suteparuk, Kearkiat Praditpornsilpa & Somchai Eiam-Ong

  2. Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand

    Piyawan Kittiskulnam, Kamonchanok Metta, Kearkiat Praditpornsilpa & Somchai Eiam-Ong

  3. Special Task Force for Activating Research in Renal Nutrition (Renal Nutrition Research Group), Office of Research Affairs, Chulalongkorn University, Bangkok, Thailand

    Piyawan Kittiskulnam, Kearkiat Praditpornsilpa & Somchai Eiam-Ong

Authors
  1. Piyawan Kittiskulnam
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  2. Mayura Nitesnoppakul
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Contributions

PK: research idea and study design. MN, KM, KP: data acquisition. SE, SS data analysis and interpretation. PK: statistical analysis. SE: supervision and mentorship. Each author contributed important intellectual content during manuscript drafting. All authors made substantial contributions, read, and approved the final manuscript.

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Correspondence to Somchai Eiam-Ong.

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Kittiskulnam, P., Nitesnoppakul, M., Metta, K. et al. Alterations of body composition patterns in pre-dialysis chronic kidney disease patients. Int Urol Nephrol 53, 137–145 (2021). https://doi.org/10.1007/s11255-020-02599-4

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