Temporal muscle thickness predicts mortality in prevalent hemodialysis patients

Kara, Ekrem; Şahutoğlu, Tuncay; Demirbaş, Sibel; Beyazal, Mehmet

doi:10.1590/1806-9282.20220844

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Revista da Associação Médica Brasileira

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Original Article • Rev. Assoc. Med. Bras. 68 (12) • 2022 • https://doi.org/10.1590/1806-9282.20220844 copy

Temporal muscle thickness predicts mortality in prevalent hemodialysis patients

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

Ultrasonographic temporal muscle thickness measurement has recently emerged as a promising method of nutritional assessment in various conditions; hence, we aimed to determine the relationship between temporal muscle thickness and mortality in prevalent hemodialysis patients.

METHODS:

Adult patients who were on a regular in-center hemodialysis program for ≥3 months were included, and patients with severe nonrenal organ failure or any recent significant disease inception were excluded. Baseline demographic; clinical, laboratory, and anthropometric data, including malnutrition inflammation score; and outcomes data were collected using a standardized form.

RESULTS:

A total of 60 patients (32 males, diabetes prevalence: 26.6%) who met the eligibility criteria participated in the study, with a mean follow-up of 33.3±11.5 months, a median age of 66.5 (interquartile range 52.7–74) years, time on hemodialysis of 36 months, and a body mass index of 25.9 kg/m². Infections and cardiovascular events were the most common causes of overall mortality that occurred in 41.6% of the patients. Temporal muscle thickness was significantly lower in nonsurvivors (8.8 vs. 10.6 mm, p<0.001). Multivariate Cox regression analysis involving age, albumin, spKt/V, and malnutrition inflammation score revealed that temporal muscle thickness was a significant predictor of mortality (hazard ratio=0.740, p=0.035). Receiver operating characteristic curve analysis has shown 68% of sensitivity and 81.8% of specificity for a cutoff value of 9.4 mm (p<0.001). Temporal muscle thickness was weakly or mildly correlated with hemodialysis vintage, body mass index, albumin, and malnutrition inflammation score and moderately correlated with age (r=−0.536, p<0.001).

CONCLUSION:

Ultrasonographic temporal muscle thickness has been found as a significant predictor of mortality in prevalent hemodialysis patients. Temporal muscle thickness could be a novel marker of nutritional status and predictor of mortality; hence, further studies are warranted.

KEYWORDS:
Temporal muscle; Malnutrition; Hemodialysis; Mortality

	All patients (n=60)	Survivors (n=35)	Nonsurvivors (n=25)	p-value
Demographics
Age (years)	66.5 (52.7–74)	60 (44–70.5)	73 (56–77.5)	0.008
Gender (male/female)	32/28	20/15	12/13	0.484
HD vintage (months)	36 (15.7–95.2)	24 (14.5–89.5)	48 (20–100.5)	0.342
Diabetes mellitus, n (%)	16 (26.6)	7 (20)	9 (36)	0.169
HD adequacy and access
spKt/V	1.4 (1.2–1.6)	1.40 (1.3–1.6)	1.30 (1.2–1.4)	0.052
Catheter, n (%)	21 (35)	9 (25.7)	12 (48)	0.074
Anthropometry
Dry weight (kg)	71.2 (59.2–80.5)	77 (62–80.2)	66.5 (57.7–82.2)	0.475
Body mass index (kg/m²)	25.9 (22.7–29.2)	26.3 (23.2–29.9)	25.4 (21–28.7)	0.419
Triceps skinfold thickness (mm)	16 (13–18)	16 (14–18)	14 (12–18)	0.135
Laboratory
Predialysis urea (mg/dL)	128.5 (105.7–151)	131 (108.5–150.5)	122 (100.5–157)	0.795
Predialysis creatinine (mg/dL)	7.4 (5.6–8.9)	7.5 (6.3–9.1)	6.6 (4.7–8.7)	0.063
Hemoglobin (g/dL)	10.9 (9.8–11.9)	10.7 (9.8–12)	11.2 (9.9–11.8)	0.832
Uric acid (mmol/L)	6.2 (5.3–6.6)	6.3 (5.4–7)	5.6 (5.2–6.5)	0.203
Sodium (mmol/L)	138 (136–140)	138 (137–140)	137 (135–139.5)	0.423
Potassium (mEq/L)	4.8 (4.3–5.4)	4.8 (4.3–5.2)	5.1 (4.2–5.4)	0.519
Calcium (mg/dL)	9 (8.7–9.5)	9.1 (8.8–9.4)	9 (8.6–9.5)	0.741
Phosphorus (mg/dL)	5.1 (4–6.5)	5 (4–6.6)	5.2 (3.9–6.3)	0.820
Intact PTH (pg/mL)	468 (231–648)	478 (226–626)	460 (198–742)	0.894
Ferritin (ng/mL)	307 (164–493)	319 (200–486)	217 (143–530)	0.428
Total cholesterol (mmol/L)	162 (145–206)	164 (147–210)	162 (141–194)	0.300
LDL (mmol/L)	93 (81–119)	95 (83–132)	90 (68.5–107)	0.179
Triglyceride (mmol/L)	116 (87–177.7)	128 (87–179)	110 (86–173)	0.499
Hs-CRP (mg/dL)	0.5 (0.1–2)	0.5 (0.1–1.9)	1.3 (0.1–2.2)	0.504
Albumin (g/L)	3.8 (3.4–3.9)	3.8 (3.6–4)	3.7 (3.2–3.8)	0.002
MIS	8.5 (6–10.2)	8 (5.5–9)	10 (8–12)	0.001
TMT-median (mm)	9.7 (8.7–10.9)	10.6 (9.5–11.4)	8.8 (8.5–10)	<0.001

TMT (median)	Correlation coefficient (r)	p-value
Age	-0.536	<0.001
HD vintage	-0.328	0.012
Dry weight	0.396	0.002
BMI	0.335	0.009
TST	0.314	0.014
Uric acid	0.368	0.004
Albumin	0.286	0.027
MIS	-0.330	0.010

Predictors of mortality	p-value	Hazard ratio	95%CI
Predictors of mortality	p-value	Hazard ratio	Lower	Upper
Age (years)	0.641	1.009	0.972	1.047
TMT (median)	0.035	0.740	0.559	0.980
spKt/V	0.176	0.250	0.033	1.862
Albumin	0.010	0.214	0.066	0.694
MIS	0.037	1.180	1.010	1.380

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[1] *Corresponding author: karaekrem79@hotmail.com