Accuracy of surrogate methods to estimate skeletal muscle mass in non-dialysis dependent patients with chronic kidney disease and in kidney transplant recipients.

Autor: Barreto Silva MI; Department of Applied Nutrition, Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, 20550-900, Brazil; Department of Applied Nutrition, Nutrition School, Federal University of the State of Rio de Janeiro, Rio de Janeiro, 22290-240, Brazil; Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, Division of Human Nutrition, University of Alberta, Edmonton, Alberta, T6G 2E1, Canada. Electronic address: inesbarreto26@gmail.com., Menna Barreto APM; Post Graduation Program in Medical Science, Rio de Janeiro State University, Rio de Janeiro, 20550-170, Brazil. Electronic address: apmennabarreto@gmail.com., Pontes KSDS; Post Graduation Program in Clinical and Experimental Pathophysiology, Rio de Janeiro State University, Rio de Janeiro, 20550-170, Brazil. Electronic address: karinescanci@gmail.com., Costa MSD; Post Graduation Program in Medical Science, Rio de Janeiro State University, Rio de Janeiro, 20550-170, Brazil. Electronic address: nutricao_mari@hotmail.com., Rosina KTC; Post Graduation Program in Medical Science, Rio de Janeiro State University, Rio de Janeiro, 20550-170, Brazil. Electronic address: kellitcnutri@gmail.com., Souza E; Nephrology Division, Rio de Janeiro State University, Rio de Janeiro, 20551900, Brazil. Electronic address: edisonmd@centroin.com.br., Bregman R; Nephrology Division, Rio de Janeiro State University, Rio de Janeiro, 20551900, Brazil. Electronic address: bregmanr@gmail.com., Prado CM; Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, Division of Human Nutrition, University of Alberta, Edmonton, Alberta, T6G 2E1, Canada. Electronic address: carla.prado@ualberta.ca., Klein MRST; Department of Applied Nutrition, Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, 20550-900, Brazil. Electronic address: marciarsimas@gmail.com.
Jazyk: angličtina
Zdroj: Clinical nutrition (Edinburgh, Scotland) [Clin Nutr] 2021 Jan; Vol. 40 (1), pp. 303-312. Date of Electronic Publication: 2020 May 26.
DOI: 10.1016/j.clnu.2020.05.021
Abstrakt: Background & Aims: Bioelectrical impedance analysis (BIA) and anthropometric predictive equations have been proposed to estimate whole-body (SMM) and appendicular skeletal muscle mass (ASM) as surrogate for dual energy X-ray absorptiometry (DXA) in distinct population groups. However, their accuracy in estimating body composition in non-dialysis dependent patients with chronic kidney disease (NDD-CKD) and kidney transplant recipients (KTR) is unknown. The aim of this study was to investigate the accuracy and reproducibility of BIA and anthropometric predictive equations in estimating SMM and ASM compared to DXA, in NDD-CKD patients and KTR.
Methods: A cross-sectional study including adult NDD-CKD patients and KTR, with body mass index (BMI) ≥18.5 kg/m 2 . ASM and estimated SMM were evaluated by DXA, BIA (Janssen, Kyle and MacDonald equations) and anthropometry (Lee and Baumgartner equations). Low muscle mass (LowMM) was defined according to cutoffs proposed by guidelines for ASM, ASM/height 2 and ASM/BMI. The best performing equation as surrogate for DXA, considering both groups of studied patients, was defined based in the highest Lin's concordance correlation coefficient (CCC) value, the lowest Bland-Altman bias (<1.5 kg) combined with the narrowest upper and lower limits of agreement (LoA), and the highest Cohen's kappa values for the low muscle mass diagnosis.
Results: Studied groups comprised NDD-CKD patients (n = 321: males = 55.1%; 65.4 ± 13.1 years; eGFR = 28.8 ± 12.7 ml/min) and KTR (n = 200: males = 57.7%; 47.5 ± 11.3 years; eGFR = 54.7 ± 20.7 ml/min). In both groups, the predictive equations presenting the best accuracy compared to DXA were SMM-BIA-Janssen (NDD-CKD patients: CCC = 0.88, 95%CI = 0.83-0.92; bias = 0.0 kg; KTR: CCC = 0.89, 95%CI = 0.86-0.92, bias = -1.2 kg) and ASM-BIA-Kyle (NDD-CKD patients: CCC = 0.87, 95%CI = 0.82-0.90, bias = 0.7 kg; KTR: CCC = 0.89, 95%CI = 0.86-0.92, bias = -0.8 kg). In NDD-CKD patients and KTR, LowMM frequency was similar according to ASM-BIA-Kyle versus ASM-DXA. The reproducibility and inter-agreement to diagnose LowMM using ASM/height 2 and ASM/BMI estimated by BIA-Kyle equation versus DXA was moderate (kappa: 0.41-0.60), in both groups. Whereas female patients showed higher inter-agreement (AUC>80%) when ASM/BMI index was used, male patients presented higher AUC (70-74%; slightly <80%) for ASM/height 2 index.
Conclusions: The predictive equations with best performance to assess muscle mass in both NDD-CKD patients and KTR was SMM-BIA by Janssen and ASM-BIA by Kyle. The reproducibility to diagnose low muscle mass, comparing BIA with DXA, was high using ASM/BMI in females and ASM/height 2 in males in both groups.
Competing Interests: Declaration of Competing Interest None declared.
(Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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