Cordelia Kheng May L.1, Jun Hao L.1, Yoke Mun C.1,4, Nor Fadhlina Z.2, Rosnawati Y.3, Zulfitri Azuan MD.1,4
1. Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
2. Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
3. Department of Nephrology, Hospital Kuala Lumpur
4. Research Center of Excellence, Nutrition and Non-Communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
This study aimed to determine the diagnostic test accuracy of bioelectrical impedance analysis derived-phase angle (BIA-derived PhA) in detecting protein energy wasting (PEW) among Malaysian hemodialysis (HD) patients.
This was a multi-center cross-sectional study conducted among 152 HD patients in Klang Valley. PEW was assessed by the criteria proposed by the International Society of Renal Nutrition and Metabolism (ISRNM). PhA at the frequency of 50kHz was measured using a multifrequency BIA machine. The relationship between PhA and other variables of interest was determined using multiple linear regression. Hierarchical logistic regression analysis was used to examine the role of PhA in detecting PEW. The gender-specific cut-off values for PhA to detect PEW were established using the receiver operating characteristics (ROC) curve analysis.
Results & Discussion
PEW existed in 21.1% of the Malaysian HD patients as per ISRNM criteria. PhA was significantly associated (p<0.05) with age (Œ≤=-0.159), gender (Œ≤=-0.153), ethnicity (Œ≤=-0.092), mid-arm muscle circumference (Œ≤=0.233), handgrip strength (Œ≤=0.305), overhydration (Œ≤=-0.441), measurement quality (Œ≤=-0.147), serum creatinine (Œ≤=0.135), and serum albumin (Œ≤=0.104) but not with marital status, education level, income level, employment, body mass index, comorbidities, and serum cholesterol (p>0.05). Hierarchical logistic regression showed that PhA is an independent predictor of PEW (adjOR=0.275, p=0.006) after multivariate adjustment. The mean PhA value is significantly lower (p<0.001) in the PEW group (3.75¬∫ ¬± 0.90) compared to the non-PEW group (4.43¬∫ ¬± 0.87). ROC curve analysis showed that PhA has excellent discriminative performance (adjAUC=0.812) to detect PEW among male patients whereas an acceptable discriminative performance (adjAUC=0.716) to detect PEW among female patients. The PhA cut-off value to detect PEW among male patients was 4.26¬∫ (sensitivity=67.7%,specificity=68.7%). Subsequently, female patients have a lower PhA cut-off value of 3.30¬∫ (sensitivity=85.5%,specificity=68.7%).
BIA-derived PhA appears as a practical and valid proxy in the clinical setting to detect PEW among Malaysian HD patients.