Influencing factors of phase angle and prediction of clinical outcome in patients with non-dialysis chronic kidney disease

Yanchao GUO; Tiantian YUE; Zhongcai WU; Ya MAO; Ting YE; Ying YAO

doi:10.16016/j.2097-0927.202305014

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Influencing factors of phase angle and prediction of clinical outcome in patients with non-dialysis chronic kidney disease

Monographic Reports: Nutritional intervention for chronic diseases | 更新时间：2026-01-09

- Influencing factors of phase angle and prediction of clinical outcome in patients with non-dialysis chronic kidney disease
- Journal of Army Medical University Vol. 45, Issue 15, Pages: 1589-1595(2023)
- 作者机构：
  
  1.430030 武汉，华中科技大学同济医学院附属同济医院: 临床营养科
  2.430030 武汉，华中科技大学同济医学院附属同济医院: 肾病内科
- 作者简介：
- 基金信息：
  
  the General Program of National Natural Science Foundation of China(82170701);the General Program of National Natural Science Foundation of China(81974087)
- DOI：10.16016/j.2097-0927.202305014
  CLC： R329.27;R459.3;R692
- Received：05 May 2023，
  
  Revised：2023-06-18，
  
  Published：15 August 2023
- 稿件说明：
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Yanchao GUO, Tiantian YUE, Zhongcai WU, et al. Influencing factors of phase angle and prediction of clinical outcome in patients with non-dialysis chronic kidney disease[J]. Journal of Army Medical University, 2023, 45(15): 1589-1595.
DOI：

Yanchao GUO, Tiantian YUE, Zhongcai WU, et al. Influencing factors of phase angle and prediction of clinical outcome in patients with non-dialysis chronic kidney disease[J]. Journal of Army Medical University, 2023, 45(15): 1589-1595. DOI： 10.16016/j.2097-0927.202305014.

摘要

目的

探讨非透析慢性肾脏病(chronic kidney disease，CKD)患者相位角(phase angle

PhA)的影响因素及临床结局预测能力。

方法

收集2019年1-11月于华中科技大学同济医学院附属同济医院肾病内科住院的60例非透析CKD患者，进行血尿生化检验、营养风险筛查与评估、SF-36生活质量调查、人体测量、握力测试及人体成分检测。根据相位角将患者分为A组(PhA > 4.5°)及B组(PhA≤4.5°)，各30例。分析相位角与营养、炎症、疾病、水分等相关指标的相关性，逐步多元线性回归分析找到相位角的主要影响因素。随访3~4年，比较两组患者生存情况。

结果

A组的血总蛋白(TP)、白蛋白(ALB)、前白蛋白(PAB)、生活质量评分、握力均明显高于B组(

＜0.05)。A组的超敏C反应蛋白(CRP)、总胆固醇(TC)、低密度脂蛋白(LDL)、24 h尿蛋白总量(UTP)、24 h尿白蛋白总量(UMA)、尿白蛋白肌酐比值(ACR)、改良SGA评分、细胞外水分比率(ECW/TBW)均明显低于B组(

＜0.05)。相关性分析显示，TP、ALB、PAB与PhA成正相关(

＜0.05)。CRP、TC、LDL、UMA、改良SGA评分、ECW/TBW与PhA成负相关(

＜0.05)。逐步多元线性回归分析显示，ECW/TBW是PhA的独立影响因素。随访发现B组的死亡率(20.00%，6/30)高于A组(6.67%，2/30)，Cox回归生存分析结果显示，年龄和PhA是影响非透析CKD患者生存率的主要因素，年龄越大，死亡风险越大，相位角每减少1°，死亡风险增加至2.605倍。

结论

在非透析CKD患者中，ECW/TBW是PhA的独立影响因素，两者呈负相关；相位角能有效预测非透析CKD患者的生存率，PhA越小，死亡风险越大。

Abstract

Objective

To investigate the influencing factors of phase angle (PhA) and its predictive ability of clinical outcome in patients with non-dialysis chronic kidney disease (CKD).

Methods

Sixty patients with non-dialysis CKD admitted to Department of Nephrology of Tongji Hospital from January to November 2019 were recruited in this study. All of them received hematuria biochemical test

nutritional risk screening and assessment

SF-36 quality of life survey

anthropometry

grip strength test and body composition detection. According to their PhA

they were divided into group A (PhA>4.5°) and group B (PhA≤4.5°)

with 30 cases in each group. The correlation of phase angle with nutrition

inflammation

disease

moisture and other related indicators was analyzed

and the main influencing factors of PhA were analyzed with stepwise multiple linear regression analysis. Follow-up was conducted for 3 to 4 years to compare the survival of patients between the 2 groups.

Results

The blood total protein (TP)

albumin (ALB)

prealbumin (PAB)

life quality score and grip strength were significantly better in group A than group B (

0.05). The high-sensitive C-reactive protei

n (CRP)

total cholesterol (TC)

low density lipoprotein (LDL)

total 24h urinary protein (UTP)

total 24h urinary albumin (UMA)

urinary albumin creatinine ratio (ACR)

modified SGA score and extracellular water (ECW/TBW) ratio were obviously lower in group A than group B (

0.05). Correlation analysis showed that TP

ALB and PAB were positively correlated with PhA (

0.05)

and CRP

LDL

UMA

modified SGA score and ECW/TBW ratio were negatively correlated with PhA (

0.05). Stepwise multiple linear regression analysis indicated that that ECW/TBW ratio was an independent factor affecting PhA. The mortality rate was high in group B (20.00%

6/30) than group A (6.67%

2/30) during follow-up. Cox regression survival analysis suggested that age and PhA were the main factors affecting the survival of non-dialysis CKD patients. The older the age

the higher the risk of death

with the risk of death being increased to 2.605 times for every 1° reduction of PhA.

Conclusion

In non-dialysis CKD patients

ECW/TBW ratio is an independent factor affecting PhA

and PhA is negatively correlated to ECW/TBW ratio. PhA can well predict the survival of these patients. And the smaller the phase angle is

the higher the mortality rate.

关键词

Keywords

references

BELLIDO D, GARCÍA-GARCÍA C, TALLURI A, et al . Future lines of research on phase angle: strengths and limitations[J ] . Rev Endocr Metab Disord, 2023, 24(3): 563-583. DOI: 10.1007/s11154-023-09803-7.

JIANG N, ZHANG J X, CHENG S M, et al . The role of standardized phase angle in the assessment of nutritional status and clinical outcomes in cancer patients: a systematic review of the literature[J ] . Nutrients, 2022, 15(1): 50. DOI:10.3390/nu15010050.

REIS F M, DA SILVA M Z C, REIS N S D C, et al . Association between phase angle and coronary artery calcium score in patients on peritoneal dialysis[J ] . Front Nutr, 2022, 9: 912642. DOI: 10.3389/fnut.2022.912642.

刘静, 尹道馨, 徐睿, 等. 改良主观全面营养评价法在慢性肾脏病患者中的应用[J]. 临床和实验医学杂志, 2012, 11(4): 243-246. DOI: 10.3969/j.issn.1671-4695.2012.04.002.

LIU J, YIN D X, XU R, et al . The application of modified Subjective Global Assessment of Nutrition (SGAN) in patients with chronic kidney diseases[J ] . J C lin Exp Med, 2012, 11(4): 243-246. DOI: 10.3969/j.issn.1671-4695.2012.04.002.

ABBASI-GHAHRAMANLOO A,SOLTANI-KERMANSHAHI M, MANSORI K, et al . Comparison of SF-36 and WHOQoL-BREF in measuring quality of life in patients with type 2 diabetes[J ] . Int J Gen Med, 2020, 13: 497-506. DOI: 10.2147/IJGM.S258953.

SHIN J H, KIM C R, PARK K H, et al . Predicting clinical outcomes using phase angle as assessed by bioelectrical impedance analysis in maintenance hemodialysis patients[J ] . Nutrition, 2017, 41: 7-13. DOI: 10.1016/j.nut.2017.02.013.

WARD L C. Bioelectrical impedance analysis for body composition assessment: reflections on accuracy, clinical utility, and standardisation[J]. Eur J Clin Nutr, 2019, 73(2): 194-199. DOI: 10.1038/s41430-018-0335-3.

黄春玲, 闫国胜, 张宏涛. 相位角在维持性血液透析中的研究进展[J]. 中国血液净化, 2022, 21(4): 273-275. DOI: 10.3969/j.issn.1671-4091.2022.04.011.

HUANG C L, YAN G S, ZHANG H T. Research progresses inthe phase angle in maintenance hemodialysis[J]. Chin J Blood Purif, 2022, 21(4): 273-275. DOI: 10.3969/j.issn.1671-4091.2022.04.011.

TAN R S, LIANG D H, LIU Y, et al . Bioelectrical impedance analysis-derived phase angle predicts protein-energy wasting in maintenance hemodialysis patients[J ] . J Ren Nutr, 2019, 29(4): 295-301. DOI: 10.1053/j.jrn.2018.09.001.

HAN B G, LEE J Y, KIM J S, et al . Clinical significance of phase angle in non-dialysis CKD stage 5 and peritoneal dialysis patients[J ] . Nutrients, 2018, 10(9): 1331. DOI: 10.3390/nu10091331.

LEE J Y, KIM J S, YANG J W, et al . Serum leptin level is associated with phase angle in CKD5 patients not undergoing dialysis[J ] . PLoS One, 2018, 13(8): e0202055. DOI: 10.1371/journal.pone.0202055.

KANG S, DO J, KIM J C. Impedance-derived phase angle is associated with muscle mass, strength, quality of life, and clinical outcomes in maintenance hemodialysis patients[J]. PLoS One, 2022, 17(1): e0261070. DOI: 10.1371/journal.pone.0261070.

SAITOH M, OGAWA M, KONDO H, et al . Bioelectrical impedance analysis-derived phase angle as a determinant of protein-energy wasting and frailty in maintenance hemodialysis patients: retrospective cohort study[J ] . BMC Nephrol, 2020, 21(1): 438. DOI: 10.1186/s12882-020-02102-2.

CHEN Y, WU J L, RAN L, et al . The combination of phase angle and age has a good diagnostic value for sarcopenia in continuous ambulatory peritoneal dialysis patients[J ] . Front Nutr, 2022, 9: 1036796. DOI: 10.3389/fnut.2022.1036796.

YOSHIDA M, ASAGIRI K, FUKAHORI S, et al . The utility of a phase angle analysis in patients with severe motor and intellectual disabilities[J ] . Brain Dev, 2017, 39(7): 557-563. DOI: 10.1016/j.braindev.2017.03.003.

HAN B G, LEE J Y, KIM J S, et al . Decreased bioimpedance phase angle in patients with diabetic chronic kidney disease stage 5[J ] . Nutrients, 2019, 11(12): 2874. DOI: 10.3390/nu11122874.

KATSURA N, YAMASHITA M, ISHIHARA T. Extracellular water to total body water ratio may mediate the association between phase angle and mortality in patients with cancer cachexia: a single-center, retrospective study[J]. Clin Nutr ESPEN, 2021, 46: 193-199. DOI: 10.1016/j.clnesp.2021.10.009.

BAE E, LEE T W, BAE W, et al . Impact of phase angle and sarcopenia estimated by bioimpedance analysis on clinical prognosis in patients undergoing hemodialysis: a retrospective study[J ] . Medicine (Baltimore), 2022, 101(25): e29375. DOI: 10.1097/MD. 0000000000029375.

D'ALESSANDRO C, BARSOTTI M, CIANCHI C, et al . Nutritional aspects in diabetic CKD patients on tertiary care[J ] . Medicina, 2019, 55(8): 427. DOI: 10.3390/medicina55080427.

WANG K, ZELNICK L R, CHERTOW G M, et al . Body composition changes following dialysis initiation and cardiovascular and mortality outcomes in CRIC (chronic renal insufficiency cohort): a bioimpedance analysis substudy[J ] . Kidney Med, 2021, 3(3): 327-334.e1. DOI: 10.1016/j.xkme.2020.12.008.

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