Association between body composition and frailty among prevalent hemodialysis patients: A US renal data system special study

Kirsten L. Johansen, Lorien Dalrymple, Cynthia Delgado, George Kaysen, John Kornak, Barbara Grimes, Glenn M. Chertow

Research output: Contribution to journalArticlepeer-review

108 Scopus citations


Studies of frailty among patients on hemodialysis have relied on definitions that substitute self-reported functioning for measures of physical performance and omit weight loss or substitute alternate criteria. We examined the association between body composition and a definition of frailty that includes measured physical performance and weight loss in a cross-sectional analysis of 638 adult patients receiving maintenance hemodialysis at 14 centers. Frailty was defined as having three of following characteristics: weight loss, weakness, exhaustion, low physical activity, and slow gait speed. We performed logistic regression with body mass index (BMI) and bioelectrical impedance spectroscopy (BIS)-derived estimates of intracellular water (ICW), fat mass, and extracellular water (ECW) as the main predictors, and age, sex, race, and comorbidity as covariates. Overall, 30% of participants were frail. Older age (odds ratio [OR], 1.31 per 10 years; 95%confidence interval [95% CI],1.14 to 1.50), diabetes (OR, 1.65; 95% CI, 1.13 to 2.40), higherfat mass (OR, 1.18; 95% CI, 1.02to 1.37), and higher ECW (OR, 1.33; 95% CI, 1.20 to 1.47) associated with higher odds of frailty. Higher ICW associated with lower odds of frailty (OR, 0.80 per kg; 95% CI, 0.73 to 0.87). The addition of BMI data did not change the area under the receiver operating characteristics curve (AUC; AUC=0.66 versus 0.66; P=0.71), but the addition of BIS data did change the AUC (AUC=0.72; P<0.001). Thus, individual components of body composition but not BMI associate strongly with frailty in this cohort of patients receiving hemodialysis.

Original languageEnglish (US)
Pages (from-to)381-389
Number of pages9
JournalJournal of the American Society of Nephrology
Issue number2
StatePublished - Feb 2014

ASJC Scopus subject areas

  • Nephrology


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