Abstract
We evaluated the validity of calf circumference (CC) measurement for nutritional assessment in 59 maintenance hemodialysis (HD) patients (male 38, female 21 ; age 71±11 years ; dialysis duration 63±43 months). The correlations with other nutritional parameters were examined. Receiver operating characteristic (ROC) curve analysis was performed to identify the cut-off levels of anthropometric parameters for predicting a Geriatric Nutritional Risk Index (GNRI) of less than 91.2. The changes in the nutritional parameters including CC during 6 months were examined in 50 patients. CC was 30.6±3.5 cm, and significantly correlated with age, body mass index, arm circumference (AC), triceps skinfold (TSF), prealbumin, albumin, and GNRI. Multivariate stepwise regression analysis showed that age, body mass index, and prealbumin were significant determinants of CC (β=−0.27, 0.71, 0.21, p=0.002, <0.001, 0.01, R2=0.71). The cut-off value of CC for predicting GNRI of less than 91.2 was 29.9 cm (sensitivity 77.4%, specificity 60.7%), and the area under the ROC curve was almost the same as that of AC (CC : 0.74 (95% confidence interval : 0.61～0.87), AC : 0.73 (0.60～0.86)). The change in CC during 6 months was−2.3±2.6%. Significant correlations were found between the changes in dry weight, AC, and GNRI, and the change in CC. Multivariate stepwise regression analysis showed that gender, and the changes in dry weight and GNRI were significant determinants of the change in CC (β=−0.29, 0.35, 0.33, p=0.03, 0.02, 0.02, R2=0.38). These results suggest that CC measurement could be a tool for nutritional assessment in HD patients.
