The relationship between phase angle, nutritional status and blood biochemical parameters in hemodialysis patients: an example study in Edirne city center

Yıl 2025, Cilt: 7 Sayı: 2, 210 - 217, 21.03.2025

Merve Pehlivan , Esra Karateke , Ebrar Çalışkan

https://doi.org/10.38053/acmj.1637989

Öz

Aims: Phase angle (PA) is recommended as a noninvasive and objective index to make an assessment of hemodialysis patients’ nutritional conditions. This study aimed to investigate the relationship of PA with nutritional status and blood biochemical parameters in patients on hemodialysis.
Methods: A descriptive and cross-sectional research design was employed. The study was conducted with 100 hemodialysis patients (mean±SD: 62.79±11.73 years) between February and July 2024. Data collection tools included a questionnaire about patients’ descriptive characteristics, a 24-hour food record form, the Global Leadership Initiative on Malnutrition (GLIM) criteria, the Malnutrition Universal Screening Tool (MUST), the 7-point Subjective Global Assessment (7p-SGA) scale, and the Nutritional Risk Screening-2002 (NRS-2002) scale.
Results: Patients with or at risk of malnutrition, identified using GLIM, MUST, and 7p-SGA criteria, had significantly lower mean PA, than patients without malnutrition risk (p=0.001, p=0.008, p=0.004, respectively). According to NRS-2002 criteria, participants who were at risk of malnutrition and needed starting a nutrition plan had significantly lower mean PA than those requiring weekly NRS-2002 assessments (p=0.017). The association of PA with lean body-mass (r=0.257, p=0.010), muscle mass
(r=0.264, p=0.008), TSF thickness (r=0.259, p=0.009) and albumin (r=0.313, p=0.002) was positive, weak or very weak, and statistically meaningful.
Conclusion: Hemodialysis patients with or at risk of malnutrition had lower PA values according to various assessment tools. This suggests that PA may function as a possible indicator for identifying nutritional deficiencies in hemodialysis patients without delay.

Anahtar Kelimeler

Phase angle, nutritional status, biochemical parameters

Etik Beyan

This study was conducted in accordance with the Declaration of Helsinki, and the approval of the Ethics Committee of Trakya University Faculty of Medicine was obtained to conduct the research (protocol no: TUTF-GOBAEK 2023/441, decision number:17/37, date: 13 November 2023).

Destekleyen Kurum

This study was supported by the TUBITAK 2209-A University Student Research Projects Support Program with the project number 1919B012334935.

Proje Numarası

1919B012334935

Kaynakça

• Kidney Disease: Improving Global Outcomes (KDIGO) diabetes work group. KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease. Kidney Int. 2022;102(5S):S1-S127. doi:10.1016/j.kint.2022.06.008
• Fouque D, Kalantar-Zadeh K, Kopple J, et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int. 2008;73(4):391-398. doi:10.1038/sj.ki.5002585
• 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: a retrospective cohort study. BMC Nephrol. 2020;21(1):438. doi:10.1186/s12882-020-02102-2
• Çalapkorur S, İradeli EA. New method for assessing nutritional status in hemodialysis patients: phase angle. J Cumhuriyet Univ Health Sci Inst. 2023;8(1):58-64. doi:10.51754/cusbed.1136058
• Tur K, Güçlü A. The independent relationship between the malnutrition-inflammation score and the C-reactive protein/albumin ratio in hemodialysis patients. J Inflamm Res. 2024;17:9325-9333. doi:10.2147/jir.s477307
• Sohrabi Z, Kohansal A, Mirzahosseini H, et al. Comparison of nutritional status assessment methods in hemodialysis patients. Clin Nutr Res. 2021;10(3):219-229. doi:10.7762/cnr.2021.10.3.219
• El Alami El Hassani N, Akrichi MA, Bajit H, Alem C. Investigation of the agreement between Global leadership initiative nutrition assessment tools and bioelectrical impedance-derived phase angle regarding malnutrition criteria in hemodialysis patients. Clin Nutr ESPEN. 2024;62:260-269. doi:10.1016/j.clnesp.2024.05.027
• Aygül RD, Mercanligil SM, Bardak Demir S. Evaluation of the relationship between dietary energy and protein intake and anthropometric measurements in hemodialysis patients. Medicine (Baltimore). 2024;103(21):e38307. doi:10.1097/MD.0000000000038307
• Wang Y, Chen Y, Zhang L, et al. Phase angle as a useful predictive indicator for protein-energy wasting and cardiovascular risk in maintenance hemodialysis patients. Sci Rep. 2024;14(1):28151. doi:10. 1038/s41598-024-78957-4
• Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149-1160. doi:10.3758/BRM.41.4.1149
• World Health Organization. Obesity and overweight [Internet]. Geneva: World Health Organization; [cited 2024 Dec 28]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
• Kubo Y, Noritake K, Nakashima D, Fujii K, Yamada K. The relationship between nutritional status and phase angle as a non-invasive method to predict malnutrition by gender in elderly patients. Nagoya J Med Sci. 2021;83(1):31-40. doi:10.18999/nagjms.83.1.31
• Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Writing group for the European working group on sarcopenia in older people 2 (EWGSOP2), and the extended group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31. doi:10.1093/ageing/afy169
• Baysal A, Aksoy M, Besler T, et al. Diyet El Kitabı. 13th ed. Hatipoğlu: 2022.
• Cederholm T, Jensen G L, Correia MITD, et al. GLIM core leadership committee; GLIM working group. GLIM criteria for the diagnosis of malnutrition-a consensus report from the global clinical nutrition community. Clin Nutr. 2019;38(1):1-9. doi:10.1016/j.clnu.2018.08.002
• Elia M. The "MUST" report: nutritional screening of adults: a multidisciplinary responsibility. Development and use of the ‘malnutrition universal screening tool’ (‘MUST’) for adults [Internet]. Redditch (UK): BAPEN; 2003 [cited 2024 Dec 28]. Available from: https://www.bapen.org.uk/pdfs/must/must-report.pdf.
• Churchill DN. Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes. J Am Soc Nephrol. 1996;17(3):198-207. doi:10.1177/089686089701703S17
• Eminsoy İO, Kızıltan G, Ok MA, Eminsoy MG, Oral EA, Sayın CB. Adaptation of the seven-point subjective global assessment (SGA-7P) to Turkish and evaluation of the concordance with SGA-3P in a pilot study with hemodialysis patients. Bes Diy Derg. 2019;47(3):34-45. doi:10. 33076/2020.BDD.1219
• Kondrup J, Rasmussen HH, Hamberg O, Stanga Z; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3): 321-336. doi:10.1016/s0261-5614(02)00214-5
• Bolayır B. Evaluation of validity and reliability of nutritional assessment test NRS-2002 (nutritional risk screening-2002) in hospitalized patients [specialization thesis]. Ankara: Hacettepe University; 2014.
• Li X, Zhang K, Guo Q, et al. Phase angle as an indicator of depression in maintenance hemodialysis patients. Kidney Dis. (Basel). 2024;10(6):468-478. doi:10.1159/000540683
• Da Silva Duarte R, Pinho CPS, Barboza YAC, Da Silva CMCS, De Carvalho TR, Lemos MCC. Association of the phase angle with nutritional status assessment parameters in hemodialysis patients. Rev Chil Nut. 2019;46(2):99-106. doi:10.4067/s0717-75182019000200099
• Zeng Y, Chen Y, Yang Y, Qiu Y, Fu P, Yuan H. Bioelectrical impedance analysis-derived phase angle predicts possible sarcopenia in patients on maintenance hemodialysis: a retrospective study. BMC Nephrol. 2024; 25(1):357. doi:10.1186/s12882-024-03787-5
• Franco-Oliva A, Ávila-Nava A, Rodríguez-Aguilar EA, et al. Association between phase angle and the nutritional status in pediatric populations: a systematic review. Front Nutr. 2023;10:1142545. doi:10.3389/fnut.2023. 1142545
• Bae E, Lee TW, Bae W, et al. Impact of phase angle and sarcopenia estimated by bioimpedance analysis on clinical prognosis in patients undergoing hemodialysis: A retrospective study. Medicine (Baltimore). 2022;101(25):e29375. doi:10.1097/md.0000000000029375
• Xu Y, Ling S, Liu Z, Luo D, Qi A, Zeng Y. The ability of phase angle and body composition to predict risk of death in maintenance hemodialysis patients. Int Urol Nephrol. 2024;56(2):731-737. doi:10.1007/s11255-023-03708-9
• Lee S, Daud ZAM, Lim J, et al. Bioelectrical impedance analysis-derived phase angle as a pragmatic screening tool for assessing sarcopenia in multi-ethnic peritoneal dialysis patients. Clin Nutr Open Sci. 2024;57:26-38. doi:10.1016/j.nutos.2024.07.007
• Martins PC, Alves Junior CAS, Silva AM, Silva DAS. Phase angle and body composition: a scoping review. Clin Nutr ESPEN. 2023;56:237-250. doi:10.1016/j.clnesp.2023.05.015
• Kang SH, Do JY. Phase angle as a risk factor for mortality in patients undergoing peritoneal dialysis. Nutrients. 2023;15(23):4991. doi:10.3390/nu15234991
• Saavedra Vásquez MA, Castañón Alonso J, Pintor de la Maza B, et al. Phase angle: differences between disease-related malnutrition, obesity and healthy people. Endocrinol Diabetes Nutr. 2024;71(10):421-426. doi: 10.1016/j.endien.2024.07.003
• Lim CK, Lim JH, Ibrahim I, et al. Bioelectrical impedance analysis derived-phase angle as a pragmatic tool to detect protein energy wasting among multi-ethnic hemodialysis patients. Diagnostics (Basel). 2021; 11(10):1745. doi:10.3390/diagnostics11101745