Body composition predicts post-KRT prognosis in AKI patients

Body composition indices, such as the lean tissue index (LTI) and body cell mass index (BCMI), predict short-term prognosis in acute kidney injury (AKI) patients receiving kidney replacement therapy (KRT), a recent study has found.

Researchers enrolled 152 severe AKI patients (mean age 62.7±15.4 years, 99 men) all of whom were treated with KRT between September 2016 and August 2018. Bioelectrical impedance analysis (BIA) was used for the body composition analysis, performed before KRT and on days 3 and 7 after KRT. The primary outcome of interest was all-cause mortality.

The 28-day, 90-day, and 1-year mortality rates were 46.7 percent, 54.6 percent, and 60.5 percent, respectively. Nonsurvivors were more likely to be admitted into intensive care, have more severe organ failure, and have reduced diastolic blood pressure. In terms of body composition, pre-KRT LTI and BCMI were comparable between survivors and nonsurvivors, but 3-day and 7-day measurements were lower in those who died.

Cox regression analysis showed that day-7 LTI (hazard ratio [HR] per standard deviation [SD], 0.37, 95 percent confidence interval [CI], 0.21–0.66; p<0.001) and BCMI (HR per SD, 0.37, 95 percent CI, 0.21–0.67; p<0.001) were significant correlates of mortality. No such effect was observed when pre-KRT or day-3 measurements were considered.

“To the best of our knowledge, this is the first article to discuss the association between repeated body composition parameters using BIA and prognosis in patients with AKI requiring KRT. We found that nutritional parameters at day 7 after KRT initiation were associated with mortality,” the researchers said.