"Phase Angle from Bioelectrical Impedance Analysis predicts Protein-Energy Wasting independently of Anorexia and Sarcopenia in patients on Hemodialysis: The H.A.S.PEW Study".

RATIONALE: Patients on hemodialysis (HD) commonly report poor nutritional status, which is associated with negative clinical outcomes. The aim of the "Hemodialysis Anorexia Sarcopenia Protein-Energy Wasting" (H.A.S.PEW) study was to determine the prevalence of protein-energy wasting (PEW) syndrome, to explore associations between PEW, anorexia, and sarcopenia, as well as to assess the diagnostic accuracy of phase angle (PhA) from bioelectrical impedance analysis (BIA) in predicting PEW in patients on HD. METHODS: The H.A.S.PEW study was a single-center, cross-sectional study in patients undergoing HD. The International Society of Renal Nutrition and Metabolism (ISRNM) criteria were used for the diagnosis of PEW by using the PEW score index. Anorexia was diagnosed by Simplified Nutritional Appetite Questionnaire (SNAQ), sarcopenia was identified by European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria and body composition was analyzed by BIA. RESULTS: A total of 190 patients (129 men; median age: 70.0 years, IQR: 58.0.-78.0) were evaluated. PEW was diagnosed in 14.7% of the patients, while 25.3% reported anorexia and 30.0% sarcopenia. Both anorexia (p < 0.001) and sarcopenia (p < 0.001) were positively associated with PEW. Patients with anorexia, sarcopenia or lower PhA values had significantly higher risk of PEW than those without anorexia, sarcopenia or with higher PhA [OR = 4.5 (1.96-10.40), p < 0.001; OR = 5.7 (2.42-13.32), p < 0.001; OR = 0.3 (0.15-0.42), p < 0.001, respectively). After adjusting for age, handgrip strength (HGS), C-reactive protein (CRP) levels, HD vintage, anorexia and sarcopenia, PhA continued to demonstrate a significant association with the development of PEW (ORadjust = 0.3, p < 0.001). Receiver Operating Characteristic (ROC) curve analysis revealed cut-off points of 4.25o for males and 4.10o for females, for the ability of PhA to identify PEW syndrome, while the agreement between PhA (PhA for the whole sample: ≤ 4.24o) and ISRNM criteria for PEW diagnosis was found to be moderate (κ = 0.414, p < 0.001). CONCLUSIONS: Anorexia and sarcopenia may increase the risk of PEW syndrome in HD patients. BIA-derived PhA seems to be a valid marker for PEW detection independently of anorexia and sarcopenia.