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Bioelectrical impedance analysis (BIA) is a non-invasive test to assess body composition and water distribution. Mortality is highly prevalent in hemodialysis (HD) patients with frailty, functional impairment (FI), nutritional and volume disturbances. Little is known about BIA as precision medicine tool to predict frailty, FI, and mortality/survival. The aim of the study was to study BIA parameters associated with frailty, FI and mortality/survival, as a tool for precision medicine, among Ecuadorian adult patients on HD.
Observational-prospective-cohort uni-center study performed between January-2021 to April-2023. Clinical Frailty Scale (CFS) score ≥4 determined frailty diagnosis and Barthel Index (BI) <70 determined FI. BCM-BIA analysis was performed in HD patients and parameters significatively related with frailty, FI and mortality/survival were identified. ROC curves, Pearson’s correlation coefficient and univariate logistic regression analysis to determine correlation and best cut-off of BIA parameters to predict outcomes were performed.
A total of 115 patients were included, 9 patients (7,8%) died. Baseline characteristics and findings are resumed in table 1. Survival was significatively related with Phase Angle (PA) (4.64°±1.11 vs 3.12°±0.62; p:0.01), Lean Tissue Index (LTI) (12.41Kg/m2 ± 3.14 vs 9.75 Kg/m2 ± 2.95; p:0.02) and Intracellular Water (ICW) (15.26L ±3.53 vs 13.23L ± 4.97; p=0.03) with moderate to strong positive correlation with survival, when compared with those who died. ROC analysis for survival showed cut-off value for PA ≥3.26° (sensitivity: 88%, specificity: 44%), LTI value ≥10.35 kg/m2 (sensitivity: 72% and specificity: 33%) and ICW value ≥13.15 L (Sensitivity: 70%, specificity: 33%) significatively related with survival.
Age (53.98 ± 14.75 vs 70.67 ± 7.14 years; p<0.001) and E/I ratio (0.97 ± 0.14 vs 1.17 ± 0.16; p<0.001) were significatively related with mortality, with positive correlation in patients who died. ROC curves showed cut-off age ≥64.5 years (sensitivity: 88%, specificity: 27%) and cut-off E/I ratio ≥0.99 (sensitivity: 78%, specificity: 23%) significatively related to mortality.
E/I ratio disturbances was significatively related with frailty and functional impairment. Moderate-positive correlation between E/I ratio and CFS score (r=-0.56, p<0.0001) and moderate-negative correlation with Barthel Index (r=-0.45, p<0.0001) were found. Cut-off value of E/I ratio for frailty and functional impairment diagnosis were ≥0.97 (Sensitivity 84%, specificity 37%) and ≥0.99 (Sensitivity 86%, specificity 37%)., respectively.
Functional impairment and non-frailty diagnosis were significatively related with PA. Moderate-positive correlation with Barthel Index (r=-0.47, p<0.0001) and moderate-strong negative correlation of PA with CFS score (r=-0.61, p<0.0001) were found. PA cut-off value for non-frailty diagnosis was ≥4.35° (Sensitivity 81%, specificity 24%) while value <3.62° (sensitivity 84%, specificity 37%) was associated with functional impairment status.
Univariate logistic regression analysis revealed that factors independently associated with frailty were age (OR=1.04, CI-95%:1.02-1.06) and PA (≥4.35°) (OR=0.17, CI-95%:0.11-0.24).
Non-invasive BIA measurement performed at patient´s point of care could be used as a precision medicine tool for earlier prediction of functional impairment, frailty, survival, and mortality in HD patients, allowing premature screening, identification and intervention in this group of patients to reduce mortality risk and complications. More studies are needed in this field.