Resting metabolic rate and its adjustments as predictors of risk protein-energy wasting in hemodialysis patients.
Resting metabolic rate and its adjustments as predictors of risk protein-energy wasting in hemodialysis patients.
复制标题
静息代谢率及其调整作为血液透析患者风险蛋白质能量浪费的预测指标。
DOI：
10.1042/bsr20210010
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发表时间：
2021-04-30
影响因子：
4
通讯作者：
Zha Y
中科院分区：
文献类型：
--
作者：
Da J;Long Y;Li Q;Yang X;Yuan J;Zha Y
背景资料：本研究的目的是探讨中国血液透析患者的静息代谢率（RMR）和蛋白质-能量消耗（PEW）风险之间的关系，按年龄和性别亚组。研究方法：采用生物电阻抗分析法（BIA）对774例血液透析患者的RMR和身体成分（体细胞量（BMI）和脂肪量）进行了测定。通过标准测量方案收集人体测量数据，并计算上臂肌围（AMC）。获得生化、营养和透析参数。采用线性回归分析法分析RMR与体成分、营养因子之间的关系。结果：平均年龄为54.96 ± 15.78岁。患者的RMR水平为1463.0（1240.5，1669.0）kcal/d。多元线性回归模型中，腰围、左小腿围度、脂肪量是影响RMR的因素（P<0.001）。在样本中的患者中，根据国际肾脏营养与代谢学会（ISRNM）标准，133例（17.2%）被诊断为PEW，363例（46.9%）处于PEW风险中。用于预测PEW风险的RMR的受试者工作特征曲线下面积（AUC）大于RMR/BSA和RMR/BSA。RMR以1481 kcal/d为界值时，其敏感性和特异性较高老年维持性血液透析（MHD）患者的AUC为0.68校正潜在混杂因素后，最低RMR四分位数水平（<1239）增加PEW的风险（OR = 4.71，95%CI：1.33-16.64，P=0.016）。结论：老年PEW患者的RMR降低较低。RMR和RMR/PEW可作为MHD患者PEW的客观筛查指标，尤其是男性患者。
Background: The purpose of the present study was to explore the association between resting metabolic rate (RMR) and protein-energy wasting (PEW) risk in Chinese hemodialysis patients by age and gender subgroup. Methods: RMR and body composition (body cell mass (BCM) and fat mass) of 774 patients undergoing hemodialysis were estimated by bio-electrical impedance analysis (BIA). Anthropometric data were collected by a standard measurement protocol, and the upper arm muscle circumference (AMC) was calculated. Biochemical nutritional and dialysis parameters were obtained. Linear regression analysis was used to analyze the relationship among RMR, body composition and nutritional factors. Results: The mean age was 54.96 ± 15.78 years. RMR level in patients was 1463.0 (1240.5, 1669.0) kcal/d. In multiple linear regression models, BCM, left calf circumference (LCC), fat mass were the determinants association with RMR (P<0.001). Among the patients in the sample, 133 (17.2%) had been diagnosed with PEW per International Society of Renal Nutrition and Metabolism (ISRNM) criteria and 363 (46.9%) were being at risk PEW. The area under the receiver-operating characteristic curve (AUC) of RMR for predicting risk PEW was greater than RMR/BCM and RMR/body surface area (BSA). When the cutoff of RMR was 1481 kcal/d it had the higher sensitivity and specificity (82 and 42%), and the AUC was 0.68 in elderly maintenance hemodialysis (MHD) patients (P<0.001). After adjustment for potential confounders, lowest RMR quartile level (<1239) increased the risk of PEW (OR = 4.71, 95% CI: 1.33–16.64, P=0.016) in all patients. Conclusions: Older patients with PEW have a lower RMR reduction. RMR and RMR/BCM may play the role in objective screening to detect risk PEW in MHD patients, especially in males.