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Nutrition in acute and chronic diseases

Change in appendicular lean mass in patients established on peritoneal dialysis as measured by dual x-ray absorptiometry (DXA) scanning

European Journal of Clinical Nutrition volume 75, pages 1254–1261 (2021)Cite this article

Subjects

Abstract

Background/objectives

Peritoneal dialysis (PD) patients are at increased risk of malnutrition and cachexia, definitions of which include weight loss. However, PD patients can absorb glucose from the dialysate and loss of muscle mass may be overlooked by fat weight gain. As such, we wished to review changes in body composition in prevalent PD patients.

Subjects/methods

We compared changes in body composition measured by dual x-ray absorptiometry (DXA) in adult PD patients, and calculated glucose absorption based on 24-h collections of PD dialysate.

Results

Overall, 73 prevalent PD patients, 60.3% male, mean age 62.5 ± 16.4 years, had DXA scans a median of 24 (15–27) months apart. Weight did not change (70.7 ± 16.8 vs. 70.9 ± 16.8 kg), with a median 198 (88–295) mmol glucose absorbed/day. Appendicular lean mass (ALM) decreased in most of the male (59%) and female (52%) patients, and the change in ALM was negatively associated with the change in percentage body fat mass (%BFM) r = −0.54, p < 0.001. Overall, 56 patients (76.7%) were admitted to hospital with intercurrent illnesses. Women who lost ALM and gained %BFM had more hospital admissions and those with an increase in %BFM had more admissions due to PD peritonitis while, in males, these outcomes were not seen.

Conclusion

Although overall weight did not change, the majority of PD patients lost ALM, and this loss of muscle mass was masked by a gain in fat mass. Definitions of malnutrition and cachexia, which include unintentional weight loss criteria will underestimate the prevalence of PD patients with loss of muscle mass.

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Fig. 1: Association between change in appendicular lean mass index per year and change in percentage body fat mass per year.

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Data availability

Availability of data and material Royal Free Hospital Renal audit data base.

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Authors and Affiliations

  1. Renal Division, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Kornchanok Vareesangthip

  2. UCL Department of Nephrology, Royal Free Hospital, University College London Medical School, London, UK

    Andrew Davenport

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  1. Kornchanok Vareesangthip
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Contributions

AD conceived the audit, KV collected and analysed the data. Both the authors contributed to first draft and approved final version.

Corresponding author

Correspondence to Andrew Davenport.

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The authors declare that they have no conflict of interest.

Ethics

Our retrospective audit was checked with, and complied with the United Kingdom (UK) National Health Service Health Research Authority guidelines for clinical audit and service development (https://www.hra.nhs.uk and https://researchsupport.admin.ox.ac.uk/sites/default/files/researchsupport/documents/media/defining-research.pdf) and registered with the Hospital. All patient data were anonymized.

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Vareesangthip, K., Davenport, A. Change in appendicular lean mass in patients established on peritoneal dialysis as measured by dual x-ray absorptiometry (DXA) scanning. Eur J Clin Nutr 75, 1254–1261 (2021). https://doi.org/10.1038/s41430-020-00836-8

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