NDT Advance Access originally published online on September 5, 2006
Nephrology Dialysis Transplantation 2006 21(12):3481-3487; doi:10.1093/ndt/gfl432
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Bioelectrical impedance can be used to predict muscle mass and hence improve estimation of glomerular filtration rate in non-diabetic patients with chronic kidney disease
1School of Sport, Health and Exercise Sciences, University of Wales-Bangor, George Building, Bangor, Gwynedd LL57 2PZ, 2Renal Unit, Ysbyty Gwynedd, Penrhosgarnedd, Bangor, Gwynedd LL57 2PW, 3Renal Unit, Ysbyty Glan Clwyd, Rhyl, Denbighshire LL18 5UJ and 4Department of Chemical Pathology and Metabolism, St Helier Hospital, Carshalton, Surrey SM5 1AA, UK
Correspondence and offprint requests to: Jamie H. Macdonald, School of Sport, Health and Exercise Sciences, University of Wales-Bangor, George Building, Bangor, Gwynedd, LL57 2PZ. Email: j.h.macdonald{at}bangor.ac.uk
Background. In this article (the second of two companion studies), we report whether bioelectrical impedance analysis (BIA) can be used to predict muscle mass in patients with chronic kidney disease (CKD), and whether using this predicted muscle mass can improve the estimation of glomerular filtration rate (GFR).
Methods. Seventy five non-diabetic patients with CKD (mean age ± SD, 65.1 ± 12.0 years; mean GFR 45.9 ± 28.8 ml/min/1.73 m2) underwent body composition analysis by dual energy X-ray absorptiometry to provide a criterion marker of skeletal muscle mass (appendicular lean mass, ALM). Validity of a published BIA equation to predict ALM was evaluated and a new BIA equation was generated (ALMBIA) and cross-validated by the leave-one-out procedure. Renal inulin clearance provided a criterion measure of GFR (GFRinu). The performance of the equation including ALMBIA to estimate GFRinu was compared with demographic variables as used in the modification of diet in renal disease (MDRD) equation, by determining bias, limits of agreement and accuracy.
Results. The previously published BIA equation to predict ALM was not valid in these patients with CKD. In contrast, our new ALMBIA equation cross-validated successfully. Compared with the MDRD demographic variables, using ALMBIA to predict GFRinu improved estimation performance, showing reduced bias (4.3 vs 15.6 ml/min) and improved limits of agreement (41.1 vs 59.2 ml/min) and accuracy (69.7 vs 39.4% of patients’ predicted GFR did not deviate by more than 30% of GFRinu).
Conclusions. ALMBIA provides a clinically obtainable and valid method to predict muscle mass in patients with CKD, and using ALMBIA improves the estimation of GFRinu. Researchers developing future GFR estimation equations should consider including ALMBIA.
Keywords: Bioelectrical impedance; body composition; creatinine; glomerular filtration rate; MDRD; muscle mass
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NDT 2006 21: 3488-3494.[Abstract] [FREE Full Text]
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  J. H. Macdonald, S. M. Marcora, M. J. Kumwenda, M. Jibani, G. Roberts, R. Glover, J. Barron, and A. B. Lemmey The relationship between estimated glomerular filtration rate, demographic and anthropometric variables is mediated by muscle mass in non-diabetic patients with chronic kidney disease Nephrol. Dial. Transplant., December 1, 2006; 21(12): 3488 - 3494. [Abstract] [Full Text] [PDF]
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