Nutritional Ultrasound for Morphofunctional Evaluation in Peritoneal Dialysis: A prospective Study

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Background: Malnutrition, sarcopenia, and protein–energy wasting (PEW) are frequent and clinically relevant in patients undergoing peritoneal dialysis (PD). Reliable and accessible tools to assess muscle and adipose tissue beyond bioimpedance are needed for routine clinical practice. Nutritional ultrasound allows bedside evaluation of regional muscle and fat compartments and may complement traditional nutritional assessment. Methods: We conducted a prospective, single-centre study in PD patients with a six-month follow-up. Nutritional ultrasound was used to assess quadriceps rectus femoris (QRF) thickness, width, and cross-sectional area, thigh supramuscular fat, and abdominal adipose layers. Ultrasound findings were integrated with bioimpedance-derived body composition indices, functional tests (handgrip strength and Short Physical Performance Battery), and nutritional scores, including the Malnutrition–Inflammation Score. PEW was defined using simplified ISRNM criteria. Results: Fifty-nine patients were included at baseline, and 45 completed the six-month follow-up. Ultrasound-derived QRF measurements showed consistent associations with lean tissue index, phase angle, handgrip strength, physical performance, and PEW severity. ROC analysis demonstrated moderate discriminatory ability of QRF thickness and reduced preperitoneal fat for identifying PEW and dynapenia. Over six months, quadriceps thickness and cross-sectional area increased, while functional performance and global nutritional scores remained stable. Fat accumulation was mainly observed in the thigh supramuscular compartment, with no significant changes in abdominal adipose layers. Sex-related differences in muscle and fat distribution were observed. Conclusions: Nutritional ultrasound is a feasible and informative tool for morphofunctional assessment and follow-up in peritoneal dialysis. It complements bioimpedance and functional evaluation by providing regional information on muscle and fat compartments and detecting longitudinal changes not captured by conventional methods. Its integration into routine PD care may support individualized nutritional monitoring. Further multicentre studies are required to define reference values and prognostic implications.

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