Kikuchi Hiroaki, Kanda Eiichiro, Mandai Shintaro, Akazawa Masanobu, Iimori Soichiro, Oi Katsuyuki, Naito Shotaro, Noda Yumi, Toda Takayuki, Tamura Teiichi, Sasaki Sei, Sohara Eisei, Okado Tomokazu, Rai Tatemitsu, Uchida Shinichi
Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Nephrology, Tokyo Kyosai Hospital, 2-3-8 Nakameguro, Meguro-ku, Tokyo, 153-8934, Japan.
Clin Exp Nephrol. 2017 Feb;21(1):55-62. doi: 10.1007/s10157-016-1251-2. Epub 2016 Feb 26.
The relationship between protein-energy wasting and chronic kidney disease (CKD) progression is unknown. In the present prospective cohort study, we evaluated the hypothesis that a combination of low body mass index (BMI) and serum albumin level is associated with rapid CKD progression.
The study cohort comprised 728 predialysis Japanese patients with CKD (stages 2-5) enrolled from 2010 to 2011. Patients were categorized into four groups according to their serum albumin levels and BMI: group 1, low serum albumin level (<4 g/dL) and low BMI (<23.5 kg/m); group 2, high serum albumin level (≥4 g/dL) and low BMI; group 3, low serum albumin level and high BMI (≥23.5 kg/m); and group 4, high serum albumin level and high BMI. The primary outcome was a 30 % decline in estimated glomerular filtration rate (eGFR) or start of dialysis within 2 years. The secondary outcome was an annual GFR decline (mL/min/1.73 m/year).
Logistic regression analysis adjusted for baseline characteristics (reference, group 4) showed that only group 1 was associated with a significant risk of CKD progression, with adjusted odds ratio of 3.51 [95 % confidence interval (CI) (1.63, 7.56)]. A multivariate linear regression analysis adjusted for baseline characteristics showed a significant difference in annual eGFR decline between groups 1 and 4 [coefficients β (standard error) -2.62 (0.75), p = 0.001].
This study suggests that combined effects of low BMI (<23.5 kg/m) and serum albumin level (<4 g/dL) are associated with CKD progression.
蛋白质 - 能量消耗与慢性肾脏病（CKD）进展之间的关系尚不清楚。在本前瞻性队列研究中，我们评估了低体重指数（BMI）与血清白蛋白水平相结合与CKD快速进展相关的假设。
研究队列包括2010年至2011年入组的728例日本CKD（2 - 5期）透析前患者。根据血清白蛋白水平和BMI将患者分为四组：第1组，低血清白蛋白水平（<4 g/dL）且低BMI（<23.5 kg/m²）；第2组，高血清白蛋白水平（≥4 g/dL）且低BMI；第3组，低血清白蛋白水平且高BMI（≥23.5 kg/m²）；第4组，高血清白蛋白水平且高BMI。主要结局是估计肾小球滤过率（eGFR）下降30%或在2年内开始透析。次要结局是每年的肾小球滤过率下降（mL/min/1.73 m²/年）。
对基线特征进行校正后的逻辑回归分析（参照组为第4组）显示，只有第1组与CKD进展的显著风险相关，校正后的优势比为3.51 [95%置信区间（CI）（1.63, 7.56）]。对基线特征进行校正后的多变量线性回归分析显示，第1组和第4组之间每年的eGFR下降存在显著差异 [系数β（标准误）-2.62（0.75），p = 0.001]。
本研究表明，低BMI（<23.5 kg/m²）和血清白蛋白水平（<4 g/dL）的联合作用与CKD进展相关。
