Lund University, Skåne University Hospital, Department of Clinical Sciences, Division of Nephrology, Lund, Sweden.
Lund University, Skåne University Hospital, Department of Laboratory Medicine, Division of Clinical Chemistry & Pharmacology, Lund, Sweden.
Nephrol Dial Transplant. 2018 Feb 1;33(2):342-348. doi: 10.1093/ndt/gfw466.
Sarcopenia and poor physical function are common in patients with chronic kidney disease (CKD). Our aim was to investigate the relationships between muscle mass and measured glomerular filtration rate (GFR) and between muscle mass and strength and balance, respectively, in patients with CKD stages 3-5.
This is a baseline data analysis of a randomized controlled clinical trial. A total of 148 adult patients with an estimated GFR <30 mL/min/1.72 m2, not on renal replacement therapy, irrespective of the number of comorbidities were included from the Department of Nephrology, Skåne University Hospital, Lund, from 2011 to 2016. Body composition was measured by dual-energy X-ray absorptiometry (DEXA). GFR was measured by iohexol clearance. Balance was measured by functional reach and the Berg balance test and strength by handgrip strength and isometric quadriceps strength.
Measured GFR ranged from 8 to 55 mL/min/1.73 m2. Lean mass (P < 0.05), fat mass (P < 0.05), appendicular skeletal muscle (P < 0.001) and appendicular skeletal muscle index (P < 0.05) were associated with GFR. Functional reach was associated with leg lean mass (P < 0.05) and the Berg balance test score was associated with trunk lean mass (P < 0.05). Handgrip strength was associated with arm lean mass (P < 0.001). Isometric quadriceps strength was associated with leg lean mass (P < 0.001). More men (44%) suffered from low muscle mass than women (22%), whereas more women (36%) suffered from low muscle strength than men (26%). However, when combining both, men (16%) suffered from sarcopenia to a greater extent than women (8%).
Among patients with CKD stages 3-5, loss of lean body mass, especially appendicular skeletal muscle, was significantly related to GFR decline. Two important markers of physical function, balance and strength, were significantly related to muscle mass. Moreover, men were more prone to sarcopenia than women during kidney function decline.
肌肉减少症和身体功能下降在慢性肾脏病（CKD）患者中很常见。我们的目的是分别研究 CKD 3-5 期患者肌肉量与估计肾小球滤过率（eGFR）和肌肉量与力量和平衡之间的关系。
这是一项随机对照临床试验的基线数据分析。2011 年至 2016 年，我们从隆德大学斯科讷大学医院肾脏病科共纳入 148 名估计 eGFR<30ml/min/1.72m2、未接受肾脏替代治疗且无论合并症数量如何的成年患者。身体成分通过双能 X 射线吸收法（DEXA）进行测量。eGFR 通过 iohexol 清除率进行测量。平衡通过功能性伸展和伯格平衡测试进行测量，力量通过握力和等长股四头肌力量进行测量。
测量的 eGFR 范围为 8-55ml/min/1.73m2。瘦体重（P<0.05）、脂肪量（P<0.05）、四肢骨骼肌（P<0.001）和四肢骨骼肌指数（P<0.05）与 eGFR 相关。功能性伸展与下肢瘦体重相关（P<0.05），伯格平衡测试评分与躯干瘦体重相关（P<0.05）。握力与手臂瘦体重相关（P<0.001）。等长股四头肌力量与下肢瘦体重相关（P<0.001）。更多的男性（44%）患有肌肉减少症，而女性（22%）则更多。然而，当两者结合时，男性（16%）比女性（8%）更容易患有肌肉减少症。
在 CKD 3-5 期患者中，瘦体重的丧失，特别是四肢骨骼肌，与 eGFR 下降显著相关。身体功能的两个重要标志物，平衡和力量，与肌肉量显著相关。此外，在肾功能下降期间，男性比女性更容易发生肌肉减少症。
