Dialysis – Transplantation
Kidney International (2005) 68, 2368–2374; doi:10.1111/j.1523-1755.2005.00699.x
Accelerated lean body mass loss in incident chronic dialysis patients with diabetes mellitus
LARA B PUPIM, OLOF HEIMBÜRGER, ABDUL RASHID QURESHI, T ALP IKIZLER and PETER STENVINKEL
Division of Nephrology, Vanderbilt University School of Medicine, Nashville, Tennessee; Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Karolinska Institutet, at Huddinge Karolinska University Hospital, Stockholm, Sweden
Correspondence: Peter Stenvinkel, M.D., Ph.D., Department of Renal Medicine, K56 Karolinska University Hospital at Huddinge, 141 86 Stockholm, Sweden. E-mail: peter.stenvinkel@klinvet.ki.se
Received 23 November 2004; Revised 4 March 2005; Re-revised 5 May 2005; Accepted 20 June 2005.
Abstract
Accelerated lean body mass loss in incident chronic dialysis patients with diabetes mellitus.
Background
End-stage renal disease (ESRD) patients display a higher incidence of poor nutritional status and are at high risk of hospitalization and death. Patients on renal replacement therapy (RRT) with a primary diagnosis of diabetes mellitus have the lowest survival rates along with highest hospitalization incidence.
Methods
In this study, we examined the importance of diabetes mellitus along with certain demographic and clinical variables in predicting the change in lean body mass (LBM) by dual-energy x-ray absorptiometry (DEXA), as a surrogate marker of somatic protein stores, in 142 incident ESRD patients (91 males, 52.8 
1.0 years, 74.2 1.2 kg body weight) among which 34 had diabetes mellitus (19 insulin-dependent and 15 noninsulin dependent).
Results
Our results show that patients with diabetes mellitus had significantly accelerated loss of LBM compared to nondiabetic patients during the first year of RRT (3.4 0.6 kg vs. 1.1 0.2 kg) (P < 0.05). Multivariate linear regression analyses revealed that the presence of diabetes mellitus was the strongest predictor of LBM loss independently of several clinically-relevant variables such as age, gender, serum albumin, presence of malnutrition, presence of inflammation, and RRT modality.
Conclusion
We conclude that the presence of diabetes mellitus is the most significant independent predictor of LBM loss in renal replacement therapy patients, providing a potential explanation as to why ESRD patients with diabetes mellitus are more prone to muscle wasting.
Keywords:
dialysis, diabetes mellitus, wasting, lean body mass, malnutrition
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