Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
Nephrol Dial Transplant. 2011 Nov;26(11):3588-95. doi: 10.1093/ndt/gfr013. Epub 2011 Mar 28.
In dialysis patients, protein-energy wasting (PEW) is associated with high mortality, and some indicators of PEW, such as serum albumin value, subjective global assessment (SGA) score and handgrip strength (HGS), may predict mortality. However, whether PEW is associated with poor renal outcomes and whether the indicators of PEW can predict renal outcomes in patients with non-dialysis-dependent chronic kidney disease (CKD-ND) is still unclear.
We enrolled 128 clinically stable patients with CKD-ND and followed up for 33.8 ± 9.2 months. Baseline characteristics, echocardiographic information, laboratory data, HGS, SGA scores, anthropometric parameters, bioimpedance analyses and other indicators of PEW were examined in relation to the risk of reaching renal composite end points of pre-dialysis mortality or dialysis-dependent end-stage renal disease.
Twenty-six patients reached composite renal end points. Multivariate Cox regression analyses showed that HGS was an independent predictor of renal outcome in patients with CKD-ND of Stages 1-5 [CKD(1-5), hazard ratio (HR) = 0.90, P = 0.004] or advanced CKD-ND of Stages 3b [defined as estimated glomerular filtration rate (eGFR) of 30-44 mL/min/1.73 m(2)] to 5 (CKD(3b-5), HR = 0.91, P = 0.031), but not serum albumin, SGA score or other indicators of PEW. When the cutoffs were set at 24.65 kg in men with CKD(1-5), 20.15 kg in men with CKD(3b-5) and 10.15 kg in women with CKD(1-5) or CKD(3b-5), which were deduced from receiver-operating characteristics analyses, patients with lower HGS had significantly poor renal outcomes in Kaplan-Meier survival analyses in all subgroups and higher HR for reaching renal end points in multivariate Cox regression analyses in all subgroups except for women with CKD(3b-5), whose HR had marginal significance (HR = 3.78, P = 0.068) after adjusting for age and eGFR.
This is the first study demonstrating that HGS is an independent predictor of composite renal outcomes in CKD-ND patients. HGS can be incorporated to clinical practice for assessing nutrition status and renal prognosis in patients with CKD-ND.
在透析患者中，蛋白质能量消耗（PEW）与高死亡率相关，PEW 的一些指标，如血清白蛋白值、主观整体评估（SGA）评分和握力（HGS），可能预测死亡率。然而，PEW 是否与不良肾脏结局相关，以及 PEW 的指标是否可以预测非透析依赖的慢性肾脏病（CKD-ND）患者的肾脏结局仍不清楚。
我们纳入了 128 例临床稳定的 CKD-ND 患者，进行了 33.8±9.2 个月的随访。根据到达透析依赖的终末期肾脏疾病或预透析死亡的复合肾脏终点的风险，检查了基线特征、超声心动图信息、实验室数据、HGS、SGA 评分、人体测量参数、生物电阻抗分析和其他 PEW 指标。
26 例患者达到了复合肾脏终点。多变量 Cox 回归分析表明，HGS 是 CKD-ND 1-5 期（CKD（1-5））或 CKD-ND 3b-5 期（定义为估计肾小球滤过率[eGFR]为 30-44 mL/min/1.73 m（2））患者肾脏结局的独立预测因子[CKD（3b-5），风险比（HR）=0.90，P=0.004]，但血清白蛋白、SGA 评分或其他 PEW 指标则不然。当根据接受者操作特征分析推断出的男性 CKD（1-5）患者 24.65 kg、男性 CKD（3b-5）患者 20.15 kg 和女性 CKD（1-5）或 CKD（3b-5）患者 10.15 kg 作为截断值时，Kaplan-Meier 生存分析显示 HGS 较低的患者在所有亚组中肾脏结局明显较差，多变量 Cox 回归分析中 HR 更高，除了女性 CKD（3b-5）患者的 HR 具有边缘意义（HR=3.78，P=0.068），该患者的 HR 经年龄和 eGFR 调整后才有意义。
这是第一项证明 HGS 是 CKD-ND 患者复合肾脏结局的独立预测因子的研究。HGS 可纳入临床实践，用于评估 CKD-ND 患者的营养状况和肾脏预后。
