肌酐清除率、步行速度与肌肉萎缩：一项队列研究。
Creatinine clearance, walking speed, and muscle atrophy: a cohort study.
作者信息
Roshanravan Baback, Patel Kushang V, Robinson-Cohen Cassianne, de Boer Ian H, O'Hare Ann M, Ferrucci Luigi, Himmelfarb Jonathan, Kestenbaum Bryan
机构信息
Division of Nephrology, Department of Medicine, University of Washington Kidney Research Institute, Seattle, WA.
Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.
出版信息
Am J Kidney Dis. 2015 May;65(5):737-47. doi: 10.1053/j.ajkd.2014.10.016. Epub 2014 Dec 24.
BACKGROUND
Chronic kidney disease is associated with malnutrition and inflammation. These processes may lead to loss of skeletal muscle and reduced physical performance. Associations of kidney function with muscle composition and longitudinal measures of physical performance are unknown.
STUDY DESIGN
Prospective cohort study.
SETTING & PARTICIPANTS: We evaluated 826 community-dwelling older adults enrolled in the Invecchiare in Chianti (InCHIANTI) Study who were free of baseline stroke or activities of daily living disability.
PREDICTOR
Baseline creatinine clearance (Clcr) based on 24-hour urine collection.
OUTCOMES
Cross-sectional and longitudinal trajectories of physical performance measured by 7-m usual gait speed, 400-m fast gait speed, and knee extension strength using isometric dynamometry. Calf muscle composition assessed by quantitative computed tomography.
RESULTS
Mean age of participants was 74 ± 7 (SD) years, with 183 having Clcr < 60 mL/min/1.73 m(2). After adjustment, each 10-mL/min/1.73 m(2) decrement in Clcr was associated with 0.01 (95% CI, 0.004-0.017) m/s slower 7-m usual walking speed and 0.008 (95% CI, 0.002-0.014) m/s slower 400-m walking speed. Each 10-mL/min/1.73 m(2) decrement in Clcr was associated with 28 (95% CI, 0.8-55) mm(2) lower muscle area and 0.15 (95% CI, 0.04-0.26) mg/cm(3) lower muscle density. After adjustment, lower Clcr was associated with slower mean 7-m (P=0.005) and 400-m (P=0.02) walk and knee extension strength (P=0.001) during the course of follow-up. During a mean follow-up of 7.1 ± 2.5 years, each 10-mL/min/1.73 m(2) lower baseline Clcr was associated with 0.024 (95% CI, 0.01-0.037) kg/y greater decline in knee strength.
LIMITATIONS
Single baseline measurement of Clcr and 3-year interval between follow-up visits may lead to nondifferential misclassification and attenuation of estimates.
CONCLUSIONS
Among older adults, lower Clcr is associated with muscle atrophy, reduced walking speed, and more rapid declines in lower-extremity strength over time.
背景
慢性肾脏病与营养不良和炎症相关。这些过程可能导致骨骼肌流失和身体机能下降。肾功能与肌肉组成及身体机能纵向指标之间的关联尚不清楚。
研究设计
前瞻性队列研究。
设置与参与者
我们评估了826名参与基安蒂地区衰老研究（InCHIANTI研究）的社区居住老年人，这些老年人无基线中风或日常生活活动障碍。
预测因素
基于24小时尿液收集的基线肌酐清除率（Clcr）。
结果
通过7米常规步态速度、400米快速步态速度以及使用等长测力法测量的膝关节伸展力量来衡量身体机能的横断面和纵向轨迹。通过定量计算机断层扫描评估小腿肌肉组成。
结果
参与者的平均年龄为74±7（标准差）岁，其中183人Clcr<60 mL/min/1.73 m²。调整后，Clcr每降低10 mL/min/1.73 m²，与7米常规步行速度减慢0.01（95%CI，0.004 - 0.017）m/s以及400米步行速度减慢0.008（95%CI，0.002 - 0.014）m/s相关。Clcr每降低10 mL/min/1.7 的肌肉面积减少28（95%CI，0.8 - 55）mm²，肌肉密度降低0.15（95%CI，0.04 - 0.26）mg/cm³。调整后，较低的Clcr与随访期间平均7米（P = 0.005）和400米（P = 0.02）步行速度减慢以及膝关节伸展力量减弱（P = 0.001）相关。在平均7.1±2.5年的随访期间，基线Clcr每降低10 mL/min/1.73 m²，与膝关节力量每年下降0.024（95%CI，0.01 - 0.037）kg相关。
局限性
Clcr的单次基线测量以及随访之间3年的间隔可能导致非差异性错误分类和估计值的衰减。
结论
在老年人中，较低的Clcr与肌肉萎缩、步行速度减慢以及随着时间推移下肢力量更快下降相关。
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