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Multicenter Study
. 2020 Nov 23;12(11):3597.
doi: 10.3390/nu12113597.

Association of Ultrasound-Derived Metrics of the Quadriceps Muscle with Protein Energy Wasting in Hemodialysis Patients: A Multicenter Cross-Sectional Study

Sharmela Sahathevan  1 , Ban-Hock Khor  2 , Birinder Kaur Sadu Singh  3 , Alice Sabatino  4 , Enrico Fiaccadori  4 , Zulfitri Azuan Mat Daud  5 , Mohammad Syafiq Ali  5 , Sreelakshmi Sankara Narayanan  6 , Dina Tallman  7 , Karuthan Chinna  8 , Bak-Leong Goh  9 , Abdul Halim Abdul Gafor  2 , Ghazali Ahmad  10   11 , Zaki Morad  12 , Pramod Khosla  7 , Tilakavati Karupaiah  6 , On Behalf Of The Patch Study Malaysia Investigators
Affiliations
Multicenter Study

Association of Ultrasound-Derived Metrics of the Quadriceps Muscle with Protein Energy Wasting in Hemodialysis Patients: A Multicenter Cross-Sectional Study

Sharmela Sahathevan et al. Nutrients. .

Abstract

This study aimed to assess muscle wasting and risk of protein energy wasting (PEW) in hemodialysis (HD) patients using an ultrasound (US) imaging method. PEW was identified using the ISRNM criteria in 351 HD patients. Quadriceps muscle thickness of rectus femoris (RF) and vastus intermedius (VI) muscles and cross-sectional area (CSA) of the RF muscle (RFCSA) were measured using US and compared with other physical measures. Associations of US indices with PEW were determined by logistic regression. Irrespective of gender, PEW vs. non-PEW patients had smaller RF, VI muscles, and RFCSA (all p < 0.001). US muscle sites (all p < 0.001) discriminated PEW from non-PEW patients, but the RFCSA compared to bio-impedance spectroscopy had a greater area under the curve (AUC, 0.686 vs. 0.581), sensitivity (72.8% vs. 65.8%), and specificity (55.6% vs. 53.9%). AUC of the RFCSA was greatest for PEW risk in men (0.74, 95% CI: 0.66-0.82) and women (0.80, 95% CI: 0.70-0.90) (both p < 0.001). Gender-specific RFCSA values (men < 6.00 cm2; women < 4.47 cm2) indicated HD patients with smaller RFCSA were 8 times more likely to have PEW (AOR = 8.63, 95% CI: 4.80-15.50, p < 0.001). The US approach enabled discrimination of muscle wasting in HD patients with PEW. The RFCSA was identified as the best US site with gender-specific RFCSA values to associate with PEW risk, suggesting potential diagnostic criteria for muscle wasting.

Keywords: hemodialysis; muscle wasting; protein energy wasting; quadriceps muscle; ultrasound imaging.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flow of patients for recruitment.
Figure 2
Figure 2
Quadriceps muscle thickness (QMT) and cross-sectional area (CSA): (a) QMT of rectus femoris (RF) and vastus intermedius (VI) muscles; (b) RFCSA.
Figure 3
Figure 3
ROC analysis for US measures according to gender. Figure 3 represents the area under curve for risk of PEW according to US muscle sites for (a) men; (b) women. Abbreviations: CSA, cross-sectional area; MID, mid-point; PEW, protein energy wasting; ROC, receiver operating characteristic; RF, rectus femoris; US, ultrasound; VI, vastus intermedius.
See this image and copyright information in PMC

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