Phase angle and mid arm circumference as predictors of protein energy wasting in renal replacement therapy patients

espanolObjetivo: analizar la asociacion entre el angulo de fase (AF) y la circunferencia media del brazo (CMB) con la presencia de desgaste proteico energetico (DPE) en pacientes en terapia de remplazo renal (TRR). Metodos: estudio transversal. Fueron incluidos pacientes en hemodiafiltracion y en dialisis peritoneal automatizada. Se tomaron mediciones de CMB y de composicion corporal utilizando bioimpedancia electrica (AF, masa libre de grasa, masa grasa y agua extracelular/agua corporal total). Se obtuvieron mediciones de albumina y colesterol y se cuantifico el consumo dietetico de energia y proteina. Se calculo el IMC. Se diagnostico el DPE utilizando los criterios de ISRNM (bajo IMC, baja albumina o colesterol, baja musculatura y sobrehidratacion). Se evaluo la habilidad del AF y CMB para predecir DPE a traves de una regresion logistica. Se obtuvieron puntos de corte para ambos indicadores utilizando una prueba ROC. Se evaluo la habilidad del AF y CMB para predecir DPE a traves de una regresion logistica. Resultados: se incluyeron 69 pacientes en el estudio, el 52% de sexo femenino, y el 39% cumplieron criterios para DPE. El AF y el CMB predicen de forma adecuada el DPE segun el analisis multivariado. Los puntos de corte obtenidos por la prueba ROC son Conclusion: el DPE esta presente en el 39% de pacientes en TRR. El AF y CMB son indicadores independientes, utiles y simples para predecir DPE en pacientes con enfermedad renal cronica en TRR. EnglishObjective: to analyze the association between phase angle (PA) and mid arm circumference (MAC) with protein energy wasting (PEW) in renal replacement therapy (RRT) patients. Methods: cross-sectional study. Hemodiafiltration (HDF) and automated peritoneal dialysis (PD) patients were enrolled in the study. MAC and body composition were measured using impedance bioelectric (BIA); PA, fat free mass (FFM), fat mass (FM) and ECW/TBW were obtained. Biochemical (serum albumin and cholesterol) and dietary data (energy and protein intake) were collected. Body mass index (BMI) was calculated. Patients were classified with PEW according to ISRNM criteria (low BMI, low albumin or cholesterol concentrations, low muscle mass and overhydration). Cut-off point of PA and MAC was obtained by ROC analysis. Logistic regression analysis was applied to evaluate the ability of both indicators to predict PEW. Results: sixty-nine patients were included in the study. Fifty-two (52%) were female. Thirty-nine (39%) patients had PEW. The ROC curve reveals that the optimal PA cut-off value for malnutrition risk was 4.64° with 77.8% sensitivity and 76.2% specificity. For MAC, a cut-off value of 29.6 cm shows a sensitivity of 66.6% and specificity of 69.0%. Both indicators showed significant association to PEW after multivariate adjustment. Conclusion: PEW is present almost in 39% of the RRT patients. PA and MAC are useful, simple and independents indicators for predicting PEW in Chronic Kidney disease patients on RRT.