Muscle atrophy, inflammation and clinical outcome in incident and prevalent dialysis patients
Muscle atrophy, inflammation and clinical outcome in incident and prevalent dialysis patients
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DOI：
10.1016/j.clnu.2008.04.007
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发表时间：
2008-08-01
影响因子：
6.3
通讯作者：
Qureshi, Abdul Rashid
中科院分区：
文献类型：
--
作者：
Carrero, Juan Jesus;Chmielewski, Michal;Qureshi, Abdul Rashid
背景与目的：肌肉萎缩被认为是终末期肾脏疾病（ESRD）中蛋白质能量消耗的最佳标志。我们测试了一个简单的观察者主观肌肉萎缩（MA）分级与ESRD患者发病率和死亡率的关系的有效性。方法：在两个不同的ESRD队列中（265名开始透析的突发患者和221名流行血液透析患者），每个患者的MA程度由训练有素的护士在1到4的范围内进行视觉评分，作为主观整体评估的一部分。该评分与炎症和营养指标以及肌肉萎缩的客观测量相结合。然后，根据队列的不同，对患者进行了长达4年或6年的前瞻性随访。结果：30%的发病率和39%的流行患者表现出MA的体征。跨越恶化的MA量表，营养。肌肉抖动的人体测量指标也越来越差。炎症标志物和女性的比例逐渐升高。在每个队列中，女性、心血管疾病、炎症和低胰岛素样生长因子-1水平与显著增加的MA奇数比相关。在调整年龄、性别、炎症、糖尿病、心血管疾病、肾小球滤过率和/或血液透析时间后，在事件组和流行组中，中度/重度MA的死亡风险比分别为2.62 （95% CI: 1.34, 5.13; p = 0.001）和3.04 （95% CI: 1.61, 5.71; p = 0.0001）。结论：MA升高在女性透析患者中更为常见，并与炎症、营养不良和人体测量状况相关，4-6年死亡率增加3倍。我们的数据支持在临床实践中使用频繁的MA和/或营养评估。(C) 2008爱思唯尔有限公司和欧洲临床营养与代谢学会。版权所有。
Background & aims: Muscle wasting is considered the best marker of protein-energy wasting in end-stage renal disease (ESRD). We tested the usefulness of a simple observer subjective muscle atrophy (MA) grading in relation to morbidity and mortality in ESRD patients.Methods: In two different ESRD cohorts (265 incident patients starting dialysis and 221 prevalent hemodialysis patients), each patient's degree of MA was visually graded by a trained nurse on a scale from 1 to 4 as part of the subjective global assessment. This score was confronted with inflammatory and nutritional indexes as well as objective measurements of muscle atrophy. Patients were then prospectively followed for up to four or six years, depending on the cohort.Results: Thirty percent of the incident and 39% of the prevalent patients presented signs of MA. Across worsening MA scale, nutritional. and anthropometric markers of muscle toss were incrementally poorer. Inflammation markers as well as the proportion of women became progressively higher. Female sex, presence of cardiovascular disease, inflammation and low insulin-like growth factor-1 levels were associated with increased significant odd ratios of MA in each cohort. After adjustment for age, sex, inflammation, diabetes, cardiovascular disease, glomerular filtration rate and/or time on hemodialysis, the hazard ratio of death for moderate/ severe MA was 2.62 (95% CI: 1.34, 5.13; p = 0.001) and 3.04 (95% CI: 1.61, 5.71; p = 0.0001) in the incident and prevalent cohorts respectively.Conclusion: Increased MA is more common in female dialysis patients and associated with inflammation, poor nutritional and anthropometric status, as well as a 3-fold increased 4-6 year mortality. Our data support the use of frequent MA and/or nutritional assessments in the clinical practice. (C) 2008 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.