Mid-Arm Muscle Circumference and Quality of Life and Survival in Maintenance Hemodialysis Patients
Mid-Arm Muscle Circumference and Quality of Life and Survival in Maintenance Hemodialysis Patients
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DOI：
10.2215/cjn.02080310
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发表时间：
2010-12-01
影响因子：
9.8
通讯作者：
Kalantar-Zadeh, Kamyar
中科院分区：
文献类型：
--
作者：
Noori, Nazanin;Kopple, Joel D.;Kalantar-Zadeh, Kamyar
背景和目的：维持性血液透析（MHD）患者中，较大的身体或脂肪质量比正常或低质量有更高的生存率。我们假设，上臂肌围（MAMC），一个方便测量的瘦体重（LBM）的替代品，比三头肌皮褶厚度（TSF），一个脂肪量的替代品，与临床结果有更强的关联。设计，设置，参与者和测量：TSF、MAMC和血清肌酐（另一种LBM替代物）的相关性，在792例MHD患者中，采用基线简表36生活质量评分和5年生存率进行了检查。在一个随机选择的子样本118名受试者，LBM测量双能X线吸收measurement.Results：双能X线吸收测量评估LBM最强烈的相关性与MAMC和血清肌酐。在调整病例组合、营养不良-炎症-恶病质综合征和炎症标志物后，较高的MAMC与较好的简明36心理健康量表和较低的死亡风险比（HR）相关。第一至第四MAMC四分位数的校正死亡HR分别为1.00、0.86、0.69和0.63。较高的血清肌酐和TSF也与较低的死亡HR相关，但这些相关性在多变量调整后减轻。使用TSF和MAMC的中位数进行二分，高MAMC与高或低TSF组合（与低MAMC/TSF相比）显示出最大的存活率，即，结论：较高的MAMC是较大LBM的替代物，并且是MHD患者更好的心理健康和更高生存率的独立预测因子。在这一患者人群中进行Sarcadia纠正干预以改善临床结局，需要进行对照试验。Clin J Am Soc Nephrol 5：2258-2268，2010. doi：10.2215/CJN.02080310
Background and objectives: Maintenance hemodialysis (MHD) patients with larger body or fat mass have greater survival than normal to low mass. We hypothesized that mid-arm muscle circumference (MAMC), a conveniently measured surrogate of lean body mass (LBM), has stronger association with clinical outcomes than triceps skinfold (TSF), a surrogate of fat mass.Design, settings, participants, & measurements: The associations of TSF, MAMC, and serum creatinine, another LBM surrogate, with baseline short form 36 quality-of-life scores and 5-year survival were examined in 792 MHD patients. In a randomly selected subsample of 118 subjects, LBM was measured by dual-energy x-ray absorptiometry.Results: Dual-energy x-ray absorptiometry assessed LBM correlated most strongly with MAMC and serum creatinine. Higher MAMC was associated with better short form 36 mental health scale and lower death hazard ratios (HRs) after adjustment for case-mix, malnutrition-inflammation-cachexia syndrome, and inflammatory markers. Adjusted death HRs were 1.00, 0.86, 0.69, and 0.63 for the first to fourth MAMC quartiles, respectively. Higher serum creatinine and TSF were also associated with lower death HRs, but these associations were mitigated after multivariate adjustments. Using median values of TSF and MAMC to dichotomize, combined high MAMC with either high or low TSF (compared with low MAMC/TSF) exhibited the greatest survival, i.e., death HRs of 0.52 and 0.59, respectively.Conclusions: Higher MAMC is a surrogate of larger LBM and an independent predictor of better mental health and greater survival in MHD patients. Sarcopenia-correcting interventions to improve clinical outcomes in this patient population warrant controlled trials. Clin J Am Soc Nephrol 5: 2258-2268, 2010. doi: 10.2215/CJN.02080310