Bioimpedance analysis (BIA) has been widely used in the evaluation of body composition in patients undergoing maintenance
hemodialysis. We conducted this study to evaluate impact of phase angle (PA) and
sarcopenia measured by BIA on clinical prognosis in these patients.This longitudinal retrospective study enrolled patients who underwent
hemodialysis between January 2016 and March 2019. The patients were stratified into higher (> 4°) and lower (≤ 4.0°) PA groups.
Sarcopenia was defined when the appendicular skeletal muscle mass was < 20 kg in men and < 15 kg in women.Of the 191 patients, 63.4% were men. The mean age was 64.2 ± 12.4 years. The lower PA group was older, had a higher proportion of women, a lower body mass index, lower
albumin,
cholesterol,
uric acid, and
phosphorus levels, and a higher incidence of history of
coronary artery disease than the higher PA group. Linear regression analysis revealed that PA was significantly associated with body mass index (B = 0.18, P = .005),
serum albumin (B = 0.23, P = .001), and
creatinine levels (B = 0.32, P < .001). During a median follow-up of 16.7 months, 14.1% (n = 27) of patients experienced major adverse cardiovascular events and 11.0% (n = 21) died. Kaplan-Meier survival analysis showed that the higher PA group had significantly better survival, regardless of
sarcopenia. Multivariate Cox analyses revealed that lower PA (0.51 [0.31-0.85], P = .010), higher IDWG (1.06 [1.01-1.12], P = .028) and
C-reactive protein level (1.01 [1.01-1.02], P < .001), and a history of
coronary artery disease (3.02 [1.04-8.77], P = .042) were significantly related to all-cause mortality after adjusting for other covariates.PA measured by BIA was an independent factor in the prediction of mortality in maintenance
hemodialysis patients, regardless of
sarcopenia. Intervention studies are needed to confirm if the improvement in PA is associated with better clinical outcome.