Bellizzi Vincenzo, Scalfi Luca, Terracciano Vincenzo, De Nicola Luca, Minutolo Roberto, Marra Maurizio, Guida Bruna, Cianciaruso Bruno, Conte Giuseppe, Di Iorio Biagio R
Nephrology and Dialysis Unit, "A. Landolfi" Hospital, Via Melito, Solofra, 83029 Italy.
J Am Soc Nephrol. 2006 May;17(5):1481-7. doi: 10.1681/ASN.2005070756. Epub 2006 Apr 12.
The aim of this study was to detect the potential occurrence of early abnormalities of body composition in patients with chronic kidney disease (CKD) at first referral to an outpatient nephrology clinic. Eighty-four patients with CKD (49 men and 35 women) were compared with 604 healthy control subjects (298 men and 306 women). Anthropometry and bioelectrical impedance analysis (BIA) were performed in all participants, whereas renal function, laboratory tests for nutritional status, and nutrient intake were assessed in the CKD group only. Creatinine clearance was 27.8 +/- 13.8 and 27.4 +/- 13.0 ml/min per 1.73 m(2) in male and female patients with CKD, respectively. No patient showed peripheral edema; frank malnutrition, defined by presence of serum albumin <3.5 g/dl plus body mass index <20 kg/m(2); or protein intake <0.6 g/kg per d. At the BIA, patients with CKD showed lower resistance (R) and abnormal mean impedance vectors for the bivariate normal distribution of R/height and reactance/height. Phase angle also was reduced (-22%), especially in patients with diabetes. When BIA-derived data were considered, total body water was slightly higher (+4.3% in men; +3.5% in women) and body cell mass was lower (-6.7% in men; -7.7% in women) in patients with CKD. No difference in either BIA parameters or nutritional indexes was observed among various CKD stages. Despite the absence of overt malnutrition, patients with CKD exhibit altered BIA variables from the early phases of renal disease. These alterations are related to the renal dysfunction, are more marked in the presence of diabetes, and mainly indicate the presence of overhydration in the absence of edema. Therefore, BIA represents an attractive clinical tool to detect impairment of body composition from the early stages of CKD.
本研究的目的是在首次转诊至门诊肾病科的慢性肾脏病（CKD）患者中检测身体成分早期异常的潜在发生情况。将84例CKD患者（49例男性和35例女性）与604例健康对照者（298例男性和306例女性）进行比较。对所有参与者进行人体测量和生物电阻抗分析（BIA），而仅在CKD组中评估肾功能、营养状况实验室检查和营养摄入。CKD男性和女性患者的肌酐清除率分别为每1.73 m² 27.8±13.8和27.4±13.0 ml/min。没有患者出现外周水肿；血清白蛋白<3.5 g/dl加上体重指数<20 kg/m² 定义的明显营养不良；或蛋白质摄入量<0.6 g/kg per d。在BIA中，CKD患者的电阻（R）较低，且R/身高和电抗/身高的双变量正态分布的平均阻抗向量异常。相角也降低了（-22%），尤其是在糖尿病患者中。当考虑BIA得出的数据时，CKD患者的总体水略高（男性+4.3%；女性+3.5%），而身体细胞质量较低（男性-6.7%；女性-7.7%）。在不同CKD阶段，BIA参数或营养指标均未观察到差异。尽管没有明显的营养不良，但CKD患者从肾病早期就表现出BIA变量的改变。这些改变与肾功能不全有关，在糖尿病患者中更明显，主要表明在无水肿的情况下存在水过多。因此，BIA是一种有吸引力的临床工具，可用于从CKD早期阶段检测身体成分的损害。
