Sarcopenia, adiposity and large discordance between cystatin C and creatinine-based estimated glomerular filtration rate in patients with cancer.
Sarcopenia, adiposity and large discordance between cystatin C and creatinine-based estimated glomerular filtration rate in patients with cancer.
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癌症患者的肌肉减少症、肥胖以及胱抑素 C 和基于肌酐的估计肾小球滤过率之间的巨大不一致。
DOI：
10.1002/jcsm.13469
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发表时间：
2024
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Hanna,PaulE;Ouyang,Tianqi;Tahir,Ismail;Katz-Agranov,Nurit;Wang,Qiyu;Mantz,Lea;Strohbehn,Ian;Moreno,Daiana;Harden,Destiny;Dinulos,JamesE;Cosar,Duru;Seethapathy,Harish;Gainor,JustinF;Shah,SachinJ;Gupta,Shruti;Leaf,DavidE;
基于肌酐的肾小球滤过率估计值（eGFRCRE）可能高估了肌减少症患者的肾功能。虽然基于胱抑素C的eGFR（eGFRCYS）受肌肉质量的影响较小，但它可能低估了肥胖患者的肾功能。我们试图评估由计算机断层扫描（CT）扫描定义的身体组成与肌酐之间的不一致性之间的关系，eGFRCRE和eGFRCYSin成人cancer.MethodsThis研究是一项横断面研究的连续成人癌症与腹部CT扫描在90天内进行的同时eGFRCRE和eGFRCYSmeasurements之间2010年5月至2022年1月。使用经验证的深度学习管道在第三腰椎椎体水平测量肌肉和脂肪组织横截面积。使用骨骼肌指数的独立性别特异性临界值（女性<39 cm 2/m2，男性<55 cm 2/m2）定义CT定义的肌肉减少症。高肥胖定义为队列中总（内脏加皮下）肥胖指数的最高性别特异性四分位数。主要结局是eGFR不一致，定义为eGFRCYS比eGFRCRE低30%;次要结局是eGFRCYS比eGFRCRE低50%。使用多变量logistic回归模型估计eGFR不一致的几率。未调整样条回归用于评估骨骼肌指数之间的关系和eGFRCYSand eGFRCRE.ResultsOf之间的差异纳入的545例患者（平均年龄63 ± 14岁，300 [55%]女性，440 [80.7%]非西班牙裔白色），320（58.7%）符合CT定义的少肌症的标准，136（25%）有高度肥胖。共有259例患者（48%）eGFR不一致性>30%，122例（22.4%）eGFR不一致性>50%。校正潜在混杂因素后，CT定义的肌肉减少症和高肥胖症均与>30%的eGFR不一致性相关（调整后的比值比[aOR] 1.90，95%置信区间[CI] 1.12-3.24; aOR 2.01，95%CI分别为1.15-3.52）和> 50%eGFR不一致（aOR 2.34，95% CI 1.21-4.51; aOR 2.23，95% CI 1.19-4.17）。样条模型表明，随着骨骼肌指数的下降，预测的差异之间的eGFRCRE和eGFRCYSwidens probably.ConclusionsCT定义的肌肉减少症和高肥胖症都独立与大eGFR不一致。从作为常规癌症护理的一部分进行的CT扫描中获得的身体成分分析中获得有价值的信息可能会影响GFR估计值的解释。
BackgroundCreatinine‐based estimated glomerular filtration rate (eGFRCRE) may overestimate kidney function in patients with sarcopenia. While cystatin C‐based eGFR (eGFRCYS) is less affected by muscle mass, it may underestimate kidney function in patients with obesity. We sought to evaluate the relationship between body composition defined by computed tomography (CT) scans and discordance between creatinine, eGFRCREand eGFRCYSin adult patients with cancer.MethodsThis study is a cross‐sectional study of consecutive adults with cancer with an abdominal CT scan performed within 90 days of simultaneous eGFRCREand eGFRCYSmeasurements between May 2010 and January 2022. Muscle and adipose tissue cross‐sectional areas were measured at the level of the third lumbar vertebral body using a validated deep‐learning pipeline. CT‐defined sarcopenia was defined using independent sex‐specific cut‐offs for skeletal muscle index (<39 cm2/m2for women and <55 cm2/m2for men). High adiposity was defined as the highest sex‐specific quartile of the total (visceral plus subcutaneous) adiposity index in the cohort. The primary outcome was eGFR discordance, defined by eGFRCYS> 30% lower than eGFRCRE; the secondary outcome was eGFRCYS> 50% lower than eGFRCRE. The odds of eGFR discordance were estimated using multivariable logistic regression modelling. Unadjusted spline regression was used to evaluate the relationship between skeletal muscle index and the difference between eGFRCYSand eGFRCRE.ResultsOf the 545 included patients (mean age 63 ± 14 years, 300 [55%] females, 440 [80.7%] non‐Hispanic white), 320 (58.7%) met the criteria for CT‐defined sarcopenia, and 136 (25%) had high adiposity. A total of 259 patients (48%) had >30% eGFR discordance, and 122 (22.4%) had >50% eGFR discordance. After adjustment for potential confounders, CT‐defined sarcopenia and high adiposity were both associated with >30% eGFR discordance (adjusted odds ratio [aOR] 1.90, 95% confidence interval [CI] 1.12–3.24; aOR 2.01, 95% CI 1.15–3.52, respectively) and >50% eGFR discordance (aOR 2.34, 95% CI 1.21–4.51; aOR 2.23, 95% CI 1.19–4.17, respectively). A spline model demonstrated that as skeletal muscle index decreases, the predicted difference between eGFRCREand eGFRCYSwidens considerably.ConclusionsCT‐defined sarcopenia and high adiposity are both independently associated with large eGFR discordance. Incorporating valuable information from body composition analysis derived from CT scans performed as a part of routine cancer care can impact the interpretation of GFR estimates.