Phase angle and associated factors in patients with chronic kidney disease on hemodialysis treatment
DOI:
https://doi.org/10.12957/demetra.2025.74267Keywords:
Hemodialysis. Chronic kidney disease. BioimpedanceAbstract
Introduction: Phase angle (PA) is a measurement derived from bioelectrical impedance that is used to assess patient prognosis as it is closely related to the patient's nutritional status. Objective: To verify the association between PA and sociodemographic, clinical, biochemical and anthropometric characteristics in patients undergoing hemodialysis treatment. Methods: Cross-sectional study conducted between 2018 and 2019 at a hemodialysis unit. Sociodemographic data were collected and anthropometric measurements (dry weight, height, handgrip strength, triciptal and subscapular skinfold thickness), body composition, and clinical data were obtained from the patients' medical records. Linear regression was used to determine the association between independent variables and PA. Results: The study sample consisted of 122 patients. There was a predominance of males, individuals who were married or with a partner, and individuals in the age group between 35 and 59. A negative association was found between age and PA (p = 0.018). A higher dry weight was associated with a higher PA (p = 0.047) and higher handgrip strength (p = 0.016). Conclusion: PA was found to be negatively associated with age and positively associated with weight and handgrip strength.
Downloads
References
1. World Kidney Day: Chronic Kidney Disease. 2015. [Acesso em 10 dez 2023]. Disponível em: http://www.worldkidneyday.org/faqs/chronic-kidney-disease/
2. Jesus NM, Souza GF de, Mendes-Rodrigues C, Almeida OP de, Rodrigues DDM, Cunha CM. Quality of life of individuals with chronic kidney disease on dialysis. Braz J Nephrol.2019;41:364-74. https://doi.org/10.1590/2175-8239-JBN-2018-0152
3. Zambelli CMSF, Gonçalves RC, Alves JTM. Diretriz BRASPEN de Terapia Nutricional no Paciente com Doença Renal. Braspen J [Internet]. July 15, 2021 [acesso 5 nov 2022];Supl2(2). Disponível em: https://a8daef65-7000-4bb3-bf33-4fd8bbca6800.usrfiles.com/ugd/a8daef_251ccb13249f4b079b19b95a02192081.ppdf
4. Balbino KP, Epifânio APS, Ribeiro SMR, da Silva LDM, Gouvea MG, Hermsdorff HHM. Comparison between direct and indirect methods to diagnose malnutrition and cardiometabolic risk in hemodialysis patients. J Hum Nutr Diet. 2017;30(5):646-54. https://doi.org/10.1111/jhn.
5. Aggarwal HK, Jain D, Chauda R, Bhatia S, Sehgal R. Assessment of Malnutrition Inflammation Score in Different Stages of Chronic Kidney Disease. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2018;39(2-3):51-61. https://doi.org/10.2478/prilozi-2018-0042.
6. Bousquet-Santos K, Costa L da G da, Andrade JMDL. Estado nutricional de portadores de doença renal crônica em hemodiálise no Sistema Único de Saúde. Ciênc Saúde Colet. 2019;24:1189-99. https://doi.org/10.1590/1413-81232018243.11192017.
7. Wang WL, Liang S, Zhu FL, Liu JQ, Chen XM, Cai GY. Association of the malnutrition-inflammation score with anthropometry and body composition measurements in patients with chronic kidney disease. Ann Palliat Med. 2019;8(5):596-603. https://doi.org/10.21037/apm.2019.10.12.
8. Carrero JJ,ThomasF,NagyK,ArogundadeF,AvesaniCM,ChanM et al. Global Prevalence of Protein-Energy Wasting in Kidney Disease: A Meta-analysis of Contemporary Observational Studies From the International Society of Renal Nutrition and Metabolism. J Ren Nutr. 2018 Nov;28(6):380-392. https://doi.org/10.1053/j.jrn.2018.08.006
9. Pimentel LR, Sampaio EJ, Sena GLHM, Ferreira FJA, Amaral RTM, Sousa SV et al. Ângulo de fase e marcadores tradicionais do estado nutricional em pacientes renais crônicos antes e após a hemodiálise. Nutr. clín. diet. Hosp., 2017;(2):125-31. https://doi.org/10.12873/372pimentel.
10. Soares V, Avelar IS de, Andrade SR de S, Vieira MF, Silva MS. Body composition of chronic renal patients: anthropometry and bioimpedance vector analysis. Rev Latino-Am Enfermagem. 2013;21:1240-7. English, Portuguese, Spanish. https://doi.org/10.1590/0104-1169.3060.2360. Erratum in: Rev Lat Am Enfermagem. 2014 Mar-Apr;22(2):346. https://doi.org/10.1590/0104-1169.0000.2422.
11. Ferreira RC, Oliveira ACM, Bastos EL, Barbosa JHP, Barbosa LB, Vasconcelos SML. Ângulo de fase como indicador prognóstico em pacientes com insuficiência cardíaca congestiva. Rev Bras Nutr Clin. 2015;30(3):201-5.
12. Martins PC, de Lima TR, Silva AM, Santos Silva DA. Association of phase angle with muscle strength and aerobic fitness in different populations: A systematic review. Nutrition. 2022;93:111489. https://doi.org/10.1016/j.nut.2021.111489.
13. Associação Brasileira de Empresas de Pesquisa. Critério de Classificação econômica Brasil. São Paulo: ABEP; 2016 [acesso 14 Nov 2022]. Disponível em: http://www.abep.org/criterio-brasil.
14. Innes E. Handgrip strength testing: A review of the literature. Aust Occ Ther J. 1999;46(3):120–40. https://doi.org/10.1046/j.1440-1630.1999.00182.x.
15. Pinto AP, Ramos CI, Meireles MS, Kamimura MA, Cuppari L. Impacto da sessão de hemodiálise na força de preensão manual. Braz J Nephrol. 2015;37:451-7. https://doi.org/10.5935/0101-2800.20150072.
16. Pereira RA, Caetano AL, Cuppari L, Kamimura MA. Espessura do músculo adutor do polegar como preditor da força de preensão manual nos pacientes em hemodiálise. Braz J Nephrol. 2013;35:177-84. https://doi.org/10.5935/0101-2800.20130029.
17. Ferraz VD, Pinho CPS, Pinho CPS, Carvalho TR de, Carvalho TR de, Barboza Y, et al. Consumo alimentar e estado nutricional de pacientes em tratamento hemodialítico/ Food consumption and nutritional status of patients under hemodialytic treatment. Braz J Dev. 2020;6(11):88467–81. https://doi.org/10.34117/bjdv6n11-317.
18. Costa J, Pinho CPS, Maio R, Diniz A da S, Carvalho TR de, Barboza Y, et al. Adequação dialítica e estado nutricional de indivíduos em hemodiálise / Dialitical adequacy and nutritional status of hemodialysis individuals. Braz J Dev. 2020;6(9):68325-37. https://doi.org/10.34117/bjdv6n9-319.
19. Borges S, Fortes RC. Indicadores de desnutrição em diálise peritoneal e hemodiálise. Brazilian Journal of Health Review. 2020;3(5):13358-76. https://doi.org/10.34119/bjhrv3n5-161.
20. Kim DH, Oh DJ. Phase angle values, a good indicator of nutritional status, are associated with median value of hemoglobin rather than hemoglobin variability in hemodialysis patients. Renal Failure. 2021;43(1):327-34. https://doi.org/10.1080/0886022X.2020.1870137.
21. Tan R shao, Liang D hua, Liu Y, Zhong X shi, Zhang D sheng, Ma J. Bioelectrical Impedance Analysis–Derived Phase Angle Predicts Protein-Energy Wasting in Maintenance Hemodialysis Patients. J Ren Nutr. 2019;29(4):295-301. https://doi.org/10.1053/j.jrn.2018.09.001.
22. Beberashvili I, Azar A, Sinuani I, Shapiro G, Feldman L, Stav K, et al. Bioimpedance phase angle predicts muscle function, quality of life and clinical outcome in maintenance hemodialysis patients. Eur J Clin Nutr. 2014;68(6):683-9. https://doi.org/10.1038/ejcn.2014.67.
23. Kang SH, Do JY, Kim JC. Impedance-derived phase angle is associated with muscle mass, strength, quality of life, and clinical outcomes in maintenance hemodialysis patients. PLOS ONE. 2022;17(1):e0261070. https://doi.org/10.1371/journal.pone.0261070.
24. Shin J, Hwang JH, Han M, Cha RH, Kang SH, An WS, et al. Phase angle as a marker for muscle health and quality of life in patients with chronic kidney disease. Clin Nutr. 2022;41(8):1651-9. https://doi.org/10.1016/j.clnu.2022.06.009.
25. Ding Y, Chang L, Zhang H, Wang S. Predictive value of phase angle in sarcopenia in patients on maintenance hemodialysis. Nutrition. 2022;94:111527. https://doi.org/10.1016/j.nut.2021.111527.
26. Di Vincenzo O, Marra M, Sacco AM, Pasanisi F, Scalfi L. Bioelectrical impedance (BIA)-derived phase angle in adults with obesity: A systematic review. Clin Nutr. 2021;40(9):5238-48. https://doi.org/10.1016/j.clnu.2021.07.035.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Danielle Cristina Guimarães da Silva

This work is licensed under a Creative Commons Attribution 4.0 International License.
STATEMENT OF AUTHORSHIP RESPONSIBILITY
Title of the manuscript:
________________________________________________________
1. Statement of responsability
I certify that I have participated in the work above specified and take public responsibility for its content.
I certify that the manuscript represents an original work and that none of the material in the manuscript has been previously published, is included in another manuscript, or is currently under consideration for publication elsewhere, whether in printed form or in electronic media, except that described in the attachment.
In case of acceptance of this text by Demetra: Alimentação, Nutrição & Saude, I declare to be in accordance with the policy of public access and copyright adopted by Demetra, which provides as follows: (a) the authors retain the copyright and grant to the Journal the right of first publication, the work being simultaneously licensed under the Creative Commons Attribution License, which allows the sharing of the work with acknowledgment of authorship and initial publication in this journal; (b) authors are authorized to enter additional contracts separately for non-exclusive distribution of the version of the work published in this journal (eg, publishing in institutional repository or book chapter), with acknowledgment of authorship and initial publication in this journal; and (c) authors are permitted and encouraged to post and distribute their work online (eg, in institutional repositories or on their personal page) at any point before or during the editorial process, as this may lead to productive changes, as well as increase the impact and citation of the published work.
2. Conflict of Interest Statement
I certify that there is no conflict of interest in connection with the submitted article.
Date, signature and full address of all authors.


