Abstract: TH-PO451

Body Composition Is Associated with Clinical Outcomes in Patients with Nondialysis-Dependent CKD

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Hung, Szu-Chun, Taipei Tzu Chi Hospital, Taipei County, Taiwan
  • Lin, Ting-yun, Teipai Tzu Chi Hospital, Taipei City, Taiwan
Background

An inverse relationship between body mass index (BMI) and mortality (the“obesity paradox”) has been demonstrated in patients with nondialysis-dependent chronic kidney disease (CKD). However, it is unclear whether increased muscle mass or body fat confers the survival advantage. We investigated the impact of body composition on the composite outcome of death or cardiovascular events in a prospective cohort of 326 patients with stage 3–5 CKD who were not yet on dialysis.

Methods

Lean mass and body fat were determined using the Body Composition Monitor (BCM), a multifrequency bioimpedance spectroscopy device, and were expressed as the lean tissue index (LTI) and fat tissue index (FTI), respectively. Patients were stratified as High (above median) or Low (below median) BMI, as High or Low LTI, or as High or Low FTI.

Results

During a median follow-up of 4.6 years, there were 40 deaths and 68 cardiovascular events. In Cox proportional hazards models, High LTI, but not High BMI or High FTI, predicted a lower risk of both the composite and its components (reference: below median). When patients were further stratified into 4 distinct body composition groups based on both LTI and FTI, only the High LTI/High FTI group had a significantly lower risk of the composite outcome (hazard ratio 0.38, 95% confidence interval 0.15–0.96; reference: Low LTI/Low FTI group).

Conclusion

LTI can provide better risk prediction than can BMI alone in nondialysis-dependent CKD patients. High LTI/High FTI appears to be associated with best outcomes. The optimal body composition for improving the prognosis of CKD needs to be determined.

Cox proportional hazards model for time to primary composite outcome
Body compositionUnadjustedModel 1Model 2
HR (95% CI)P valueHR (95% CI)
P valueHR (95% CI)P value
BMI (H vs L)0.72 (0.47–1.11)
0.1360.87 (0.57–1.33)
0.5170.91 (0.58–1.43)
0.687
FTI (H vs L)1.41 (0.92–2.17)
0.1161.06 (0.67–1.68)
0.8030.96 (0.59–1.55)
0.860
LTI (H vs L)0.31 (0.19–0.49)
0.0000.45 (0.26–0.78)
0.0050.52 (0.30–0.91)
0.021