Associations of body size and body composition with functional ability and quality of life in hemodialysis patients

Abstract

Background and objectives: Modifiable factors, such as body size and body composition, could influence physical function and quality of life in patients undergoing maintenance hemodialysis (MHD).

Design, setting, participants, & measurements: From January 2008 to June 2012, in body mass index (BMI), waist circumference (WC), and magnetic resonance imaging measurements of midthigh muscle area (MTMA) and intra-abdominal fat area (IAFA) were obtained at baseline in 105 MHD patients. Six-minute walk distances and physical and mental component scores (PCS and MCS) from the Short Form-12 questionnaire were obtained at baseline and 6 and 12 months. Separate mixed-effects regression models were used to relate baseline BMI, WC, and IAFA with baseline and the average of follow-up 6-minute walk distances and PCS and MCS after adjustment for baseline covariates and MTMA.

Results: for baseline covariates and baseline MTMA, each SD increase in baseline BMI was inversely associated with baseline (-31.5 m; 95% confidence interval [95% CI], -53.0 to -10.0 m) and follow-up (-36.9 m; 95% CI, -54.6 to -19.2 m) 6-minute walk distances. Results were similar for WC and IAFA. In each of these models, each SD increase in MTMA had a strong positive association with 6-minute walk distance. Adiposity measures were not associated with baseline or follow-up PCS and MCS. After adjustment for baseline BMI, each SD increase in baseline MTMA was associated with higher baseline PCS score (3.78; 95% CI, 0.73 to 6.82) and MCS (3.75; 95% CI, 0.44 to 7.05) but had weaker associations with follow-up PCS and MCS.

Conclusions: Body size and composition are significantly associated with physical functioning and quality of life. Interventions that improve muscle mass and decrease obesity might improve these measures in patients undergoing MHD.

Keywords: chronic kidney disease; hemodialysis; quality of life.

Copyright © 2014 by the American Society of Nephrology.

Figures

Figure 1.

Flowchart of study participants.

Figure 2.

Associations of baseline body size and body composition measures with baseline and average follow-up 6-minute walk distances in mixed-effects models. BMI, body mass index.

Figure 3.

Associations of baseline body size and body composition* measures with baseline and average follow-up physical component scores in mixed-effects models.

Figure 4.

Associations of baseline body size and body composition* measures with baseline and average follow-up mental component scores in mixed-effects models.