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Linear regression curve between phase angle and handgrip strength, torque peak of knee extensors, IGF1, and quality of life questionnaire. Abbreviations: kgf, kilogram/force; DLL, dominant lower limb; Nm, Newton; IGF1, growth factor similar to insulin type 1; mg/dL, milligram per decilitre; KQDOL, kidney disease quality of lif short form
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Background
Chronic kidney disease is a systemic disease affecting not only renal function, but also endocrine, cardiovascular, and skeletal muscle systems, with broad impact on functionality. Therefore, the assessment of body composition, peripheral muscle function, and exercise tolerance is also of great importance in this population. In addition,...
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Introduction
Neuromuscular electrical stimulation (NMES) as an adjunctive strategy to increase isolated muscular strength or endurance has been widely investigated in patients with chronic kidney disease (CKD) undergoing haemodialysis (HD). However, the efficacy of combined low and high frequencies, to improve both muscular strength and endurance,...
Citations
... Notably, it appeared that for each increase in value of MIS, there was a 30% higher chance to die from COVID-19 infection. In our study we did not evaluate quality of life, long term symptoms, such as cognitive dysfunction, or performance status, but some authors have demonstrated that variables such as MIS and PhA are associated with long term worse outcomes [26-28], and our group have previously demonstrated that PhA is associated with handgrip strenght as a marker of functionality in dialysis patients [29] . ...
Background
Patients with comorbidities, such as chronic renal disease, are susceptible to severe COVID-19 infection. Dialysis patients have a high prevalence of malnutrition, and it has been demonstrated association between nutritional status and several unfavorable outcomes in this population. The aim of this study was to assess nutritional status through Malnutrition-Inflammation Score (MIS) and phase angle (PhA), along with demographic and biochemical indicators and verify whether they are predictive variables of outcomes in dialysis patients with COVID-19 infection.
Methods
An observational, retrospective, cross sectional type study was undertaken in a Nephrology and Dialysis center in a tertiary hospital at São Paulo city. We evaluated data from EMR from 37 dialysis patients who had COVID-19 infection (RT-PCR) between march 2020 and december 2021. A Logistic regression was used in order to evaluate risk factors associated with mortality. Then we compared with a cohort of 31 dialysis patients infected with COVID-19 in the post-vaccionation period.
Results
Regarding MIS, age, and phase angle (PhA), we observed that for each unit increase in MIS previously to COVID-19 infection, there was a 30% increase in mortality risk (adj OR = 1.3, CI 1.0-1.8, p = 0.068) and that patients above 65 years had 8 times higher chance to die (adj OR = 8.8, CI 0.8–102, p = 0.082). Yet, for each unit increase in PhA, there was a 50% decrease in death risk (adj OR = 0.5, IC 0.2–1.1, p = 0.097), although no significance was found after logistic regression. After immunization, we found a attenuation of impact of nutritional status after COVID-19 infection, as demonstrated by a small, non-significant increase in MIS score, and with a low hospitalization need and no death.
Conclusions
The present study demonstrated a trend that age is the main variable determining outcomes of COVID-19 infection in dialysis patients. Besides that, we demonstrated the importance of nutritional status (MIS e PhA), since it appears to increase mortality risk when baseline nutritional status is worse and compromised after the COVID-19 infection, which was clearly abrogated with vaccination.
... In patients with CKD, lower PhA values were associated with unfavorable clinical outcomes, such as protein energy-wasting, frailty, infection, cardiovascular and allcause mortality [15][16][17][18]. Furthermore, Brito et al. [19] observed a high correlation between PhA and exercise tolerance, another variable associated with mortality, in a sample of HD patients. ...
... The skin of these regions was cleaned with a 70% alcohol swab before placing the electrodes. All metallic materials were removed from the patient's proximity for evaluation [19]. The measured variables were: lean tissue index (LTI), fat tissue index (FTI) and PhA. ...
... The predictive value was calculated using the reference equation proposed by Arcuri et al. [32]. Based on previous studies, in which HD patients presented performance close to 50% of the normal values in the field tests [19,33,34], the reduced exercise tolerance was defined by performance less than or equal to 50% of the predicted value in the 6MST. ...
Background
Phase angle (PhA) is a prognostic marker of all-cause mortality in chronic kidney disease. However, no study has investigated this marker as a predictor of exercise intolerance in hemodialysis (HD) patients. The aim of this study was to determine a cut-off point for the PhA capable of discriminating HD patients with reduced exercise tolerance.
Methods
Thirty-one patients (80.6% men, median age 69 years) were included. The evaluations were performed on three different days, before the HD session. The outcomes evaluated were: biochemical markers, inflammatory and nutritional status, body composition, peripheral muscle strength and exercise tolerance. Performance ≤50% of the predicted value in the six-minute step test (6MST) was defined as reduced exercise tolerance.
Results
Patients presented an average of 67.6 steps (50.5% of predicted) in the 6MST. Fifteen patients (48.4%) were classified with reduced exercise tolerance. The receiver operating characteristic curve indicated a cut-off point of 3.73° for the PhA (sensitivity = 87%, specificity = 81%, and area under the curve = 0.88 [95% CI: 0.76–1.00]; p < 0.001). Patients with reduced exercise tolerance had worse inflammatory and nutritional status, lower PhA and greater impairment of peripheral muscle strength.
Conclusion
The cut-off point of 3.73° for the PhA is sensitive and specific to discriminate HD patients with reduced exercise tolerance.
Trial registration
This study was registered in the Clinical Trials database (no. NCT03779126, date of first registration 19/12/2018).
... The association between PhA and the ability to walk in older adults and patients with various diseases has already been reported in several reports 6,[13][14][15][16][17] ; however, this association has not been investigated for VCF. This study analyzed the association between PhA and the ability to walk independently in older adults with VCF. ...
Objectives: This study aimed to clarify whether phase angle can be a predictor of walking independence in older women with vertebral compression fractures (VCFs) and to determine a clinically usable cutoff value.
Methods: We retrospectively assessed data of older women (n=59; median age, 83.0 years) with VCFs. Propensity score-matching and logistic regression were performed to examine the association between phase angle at admission and walking independence at discharge. The cutoff value for the phase angle at admission for predicting walking independence was calculated based on the receiver operating characteristic curve.
Results: Thirty-one patients (52.5%) could walk independently at discharge. Thirty patients were extracted from the independent and non-independent groups according to the propensity score. After propensity score matching, there was no significant difference between the groups for age, medical history, knee extension strength, skeletal muscle mass index, mini nutritional assessment-short form score, or revised Hasegawa’s dementia scale score. However, the phase angle of the independent group was significantly higher than that of the non-independent group (P<0.05). Logistic regression revealed that phase angle at admission was significantly associated with walking independence at discharge (odds ratio, 12.2; 95% confidence interval, 2.1–72.0; P<0.01). The area under the receiver operating characteristic curve was 0.868, and the calculated phase angle cutoff value was 3.55°.
Conclusions: This study revealed that the phase angle can predict walking independence in older women with VCFs. The cutoff values for women calculated in this study can be used as a simple and objective predictive index of walking independence.
... These findings support the suggestion that the PhA could be a useful biomarker to estimate physical performance [18,45,46]. Besides functional performance, the PhA has been shown to correlate with muscle strength or power [47,48], knee extensor strength [49] and maximal torque of plantar and dorsal flexion [50], in middle-aged or older populations [51]. ...
In recent years, the phase angle (PhA) as a raw bioelectrical impedance analysis variable has gained attention to assess cell integrity and its association to physical performance in either sports-related or clinical settings. However, data on healthy older adults are scarce. Therefore, data on body composition, physical performance and macronutrient intake from older adults (n = 326, 59.2% women, 75.2 ± 7.2 years) were retrospectively analyzed. Physical performance was evaluated by the Senior Fitness Test battery, gait speed, timed up and go and handgrip strength. Body composition was determined by the BIA and dual-energy X-ray absorptiometry (from a subgroup of n = 51). The PhA was negatively associated with the timed up and go test and age (r = −0.312 and −0.537, p < 0.001), and positively associated with the 6 min walk test, 30 s chair stand, handgrip strength, gait speed and physical performance score (r = 0.170–0.554, p < 0.05), but not protein intake (r = 0.050, p = 0.386). Hierarchical multiple regression analysis showed that especially age, sex, BMI, but also the PhA predicted the performance test outcomes. In conclusion, the PhA seems to be an interesting contributor to physical performance, but sex- and age-specific norm values still need to be determined.
... Although the relationship between PhA and physical function in PD is still not well-established, there are studies associating PhA with muscle function in other CKD populations. Muscle function, assessed by handgrip strength, was associated with PhA in maintenance hemodialysis (28,29) and kidney transplant recipients (30). Moreover, in the hemodialysis patients, PhA was associated with exercise tolerance, which was assessed by a 6-min step test, and peak torque of knee extensors (28). ...
... Muscle function, assessed by handgrip strength, was associated with PhA in maintenance hemodialysis (28,29) and kidney transplant recipients (30). Moreover, in the hemodialysis patients, PhA was associated with exercise tolerance, which was assessed by a 6-min step test, and peak torque of knee extensors (28). ...
Introduction: Muscle mass depletion, overhydration, and inflammatory state have been related to impaired physical function in chronic kidney disease patients. The relationship between bioelectrical impedance analysis (BIA) parameters, such as hydration status and phase angle (PhA), with physical function in peritoneal dialysis (PD), is still not well-established. Therefore, the objective was to evaluate the association of BIA parameters (overhydration index and PhA) and inflammatory markers with physical function in patients on PD.
Methods: The present cross-sectional study enrolled PD patients. Multifrequency BIA was performed to obtain overhydration index and PhA. The Short Physical Performance Battery (SPPB) test battery was applied to assess physical function. The time to complete the 4-m gait test and sit-to-stand test was also considered for physical function assessment. The inflammatory markers tumor necrosis factor-alpha and C-reactive protein levels were determined. Multiple linear regression models were performed, with the physical function variables as dependent variables, adjusted for age, diabetes, and sex.
Results: Forty-nine PD patients were enrolled, 53.1% (n = 26) women; mean age, 55.5 ± 16.3 years. There were significant correlations between PhA and SPPB (r = 0.550, p < 0.001), time of 4-m gait test (r = −0.613, p < 0.001) and sit-to-stand test and (r = −0.547, p < 0.001). Overhydration index was significantly correlated with SPPB, 4-m gait test (r = 0.339, p = 0.017), and sit-to-stand test (r = 0.335, p = 0.019). Inflammatory markers were not significantly correlated with physical function parameters. In the multiple linear regression analysis, PhA was associated with physical function parameters, even after adjustments. Overhydration index was associated with all physical function tests only in the models with no adjustments.
Conclusion: PhA was independently associated with physical function in PD patients. Inflammatory markers and overhydration index were not associated with physical function.
