#3914 TRAJECTORY OF ANTHROPOMETRIC INDICATOR AND CLINICAL EVENTS AMONG PATIENTS ON HEMODIALYSIS
Authors: Yoshikoshi Shun , Suzuki Yuta , Yamamoto Shohei , Imamura Keigo , Harada Manae , Fukuzaki Narumi , Tobita Asumi , Nikkawa Sayaka , Osada Shiwori , Matsunaga Atsuhiko 
Published: June 2023

Background and Aims

Low values for anthropometric indicators are risk factors for adverse clinical outcomes among patients on hemodialysis (HD). Anthropometric parameters are time-dependent; thus, reliance on only baseline measurements may not sufficiently capture important patient outcomes. Nonetheless, little is known about the associations between the trajectory of anthropometric indicators and prognosis. We examined associations between a one-year change in anthropometric indicators and hospitalization and mortality rates in patients undergoing HD.

Method

This retrospective study collected data from outpatients undergoing HD at two dialysis facilities between April 2018 and March 2022. The five anthropometric measurements were evaluated, including body mass index (BMI), mid-upper arm circumference (MUAC), mid-arm muscle circumference (MAMC), triceps skinfold (TSF), and calf circumference (CC). We defined baseline which was the date of the first measurement of anthropometric assessments. Thereafter, we evaluated their trajectories over one year. Change in anthropometric indicators over the 1-year was calculated by subtracting the baseline value from the second assessment value. Patients were divided into 2 groups according to a one-year change in anthropometric indicators: no decline (≥0) and decline (&lt;0). The outcomes were all-cause death and the number and duration of all-cause hospitalizations. Death and hospitalizations were determined using the facilities’ records. Negative binomial regressions were used to examine the associations between anthropometric changes and clinical outcomes.

Results

We included 283 patients (mean age, 67.3 years; 60.4% males). During the follow-up period (median, 2.7 years), 30 deaths and 200 hospitalizations occurred. When considering anthropometric measurements trajectories as continuous variables, increasing BMI per 1 standard deviation (incident rate ratio [IRR]: 0.87; 95% confidence interval [CI]: 0.85–0.90), MUAC (IRR: 0.94; 95% CI: 0.88–0.99), TSF (IRR: 0.92; 95% CI: 0.84–0.99), and MAMC (IRR: 0.99; 95% CI: 0.98–0.99) were associated with a lower risk of all-cause hospitalizations and death regardless of their value at any one point in time. However, the CC trajectory was not associated with clinical events (IRR: 0.94; 95% CI: 0.83–1.07). Similarly, when the anthropometric changes were considered in the categorical models, the group with BMI decline (IRR: 1.36, 95% CI: 1.30–1.43), MUAC decline (IRR: 1.14, 95% CI: 1.02–1.28), TSF decline (IRR: 1.27, 95% CI: 1.05–1.53), and MAMC decline (IRR: 1.11, 95% CI: 1.03–1.19) had a higher risk of the clinical outcome than the no decline group. A significant association was not detected for CC decline (IRR: 0.93, 95% CI: 0.84–1.03) (Table 1).

Conclusion

We observed that decreasing BMI, MUAC, TSF, and MAMC over time were independently associated with clinical events. Routinely assessing these simple measures in clinical practice may be a useful management strategy for the prognostic stratification of patients undergoing HD.