#1848 Body composition and multimorbidity in patients with chronic kidney disease

Frailty and multimorbidity are increasingly prevalent, particularly in the chronic kidney disease (CKD) population, and they seem to be more pronounced and accelerated in people receiving haemodialysis. We aimed to study the relationship between body composition, frailty and multimorbidity in people with CKD and end stage renal disease (ESRD) on haemodialysis (HD).

This was a single centre study, involving 42 patients with CKD stage 3 to 5 (pre-dialysis) and 29 patients receiving in-centre haemodialysis. InBody 770 was used to measure body composition using bioelectrical impedance analysis. Multimorbidity of participants were assessed using the simplified Cambridge multimorbidity score. Frailty assessment was performed using the Clinical Frailty Scale.

Phase angle was lower in later stages of CKD—mean phase angle in CKD stage 3 was 5.28°, stage 4 was 4.44 and stage 5 was 4.13 (p = 0.008). Visceral adiposity correlated with multimorbidity scores but in a multivariate regression analysis (including albumin and visceral fat area) only whole body phase angle independently predicted multimorbidity in CKD stage 4-5 (adjusted R² for the whole model = 0.47, p = 0.007). In haemodialysis patients, there was no correlation between multimorbidity and phase angle (r = −0.149, p = 0.441). However, there was a significant correlation between frailty score and whole body phase angle in this group (r = −0.559, p = 0.002). In a univariate analysis, age (R² = 0.2, Beta = 0.045, p = 0.015), albumin (R² = 0.217, Beta = −0.214, p = 0.009) and skeletal muscle mass (R² = 0.282, Beta = −0.101, p = 0.003) predicted frailty score in haemodialysis patients. In multivariate regression analysis age, albumin level and skeletal muscle mass continued to independently predict frailty scores in HD patients (adjusted R² for the whole model = 0.503).

Phase angle measurement refers to cell membrane integrity and fat-free mass, with higher values suggesting improved cell health. Using body composition measures, in particular phase angle, is a useful measure to predict multimorbidity and frailty in CKD patients. They are quick, accessible and easy to use tools that can be incorporated in clinical practice routinely. The relationship between visceral adiposity and multimorbidity merits further investigation. Preservation of skeletal muscle mass through nutritional and exercise interventions could be a clinical target to reduce frailty in this population.