Polinder-Bos Harmke A, Nacak Hakan, Dekker Friedo W, Bakker Stephan J L, Gaillard Carlo A J M, Gansevoort Ron T
Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Kidney Int Rep. 2017 Mar 10;2(4):676-685. doi: 10.1016/j.ekir.2017.02.021. eCollection 2017 Jul.
Frailty and muscle wasting, a component of frailty, are common in advanced stage chronic kidney disease (CKD). Whether frailty is associated with low urinary creatinine excretion (UCrE) as a measure of muscle mass in this population is unknown. Furthermore, reference values of UCrE are lacking. We first defined low UCrE and studied correlates of low UCrE, and subsequently studied cross-sectional associations of frailty with low UCrE in patients with advanced CKD.
A total of 2748 healthy individuals of the general population-based PREVEND study were included to define low UCrE (UCrE indexed for height, below the age- and sex-specific 5th percentile of the distribution). Frailty was defined using a modification of the Fried frailty phenotype. In a CKD population that included 320 and 967 participants of the PREPARE-2 and NECOSAD studies, respectively, cross-sectional associations of self-reported frailty, the individual components that define self-reported frailty, and frailty-associated variables with low UCrE were evaluated using multivariate logistic and linear regression models.
Low UCrE was found in 38% of the CKD patients. A lower glomerular filtration rate was strongly associated with low UCrE. Self-reported frailty (adjusted odds ratio: 2.19; 95% confidence interval: 1.28-3.77) and the individual components were associated with low UCrE, independent of comorbidities. The frailty-associated variables hemoglobin and albumin were inversely associated with low UCrE, and parathyroid hormone was positively associated with low UCrE.
Lower kidney function is a strong correlate of low UCrE and self-reported frailty, and the individual frailty components are associated with low UCrE as well, independent of comorbidities.
衰弱及作为衰弱一部分的肌肉萎缩在晚期慢性肾脏病（CKD）中很常见。在该人群中，衰弱是否与作为肌肉量指标的低尿肌酐排泄量（UCrE）相关尚不清楚。此外，UCrE的参考值也缺乏。我们首先定义了低UCrE并研究了低UCrE的相关因素，随后研究了晚期CKD患者中衰弱与低UCrE的横断面关联。
纳入基于一般人群的PREVEND研究中的2748名健康个体以定义低UCrE（根据身高校正的UCrE，低于年龄和性别特异性分布的第5百分位数）。使用改良的Fried衰弱表型定义衰弱。在分别包括PREPARE - 2研究的320名参与者和NECOSAD研究的967名参与者的CKD人群中，使用多变量逻辑回归和线性回归模型评估自我报告的衰弱、定义自我报告衰弱的个体组成部分以及与衰弱相关的变量与低UCrE的横断面关联。
38%的CKD患者存在低UCrE。较低的肾小球滤过率与低UCrE密切相关。自我报告的衰弱（调整后的优势比：2.19；95%置信区间：1.28 - 3.77）及其个体组成部分与低UCrE相关，且独立于合并症。与衰弱相关的变量血红蛋白和白蛋白与低UCrE呈负相关，甲状旁腺激素与低UCrE呈正相关。
较低的肾功能是低UCrE和自我报告衰弱的强相关因素，并且个体衰弱组成部分也与低UCrE相关，且独立于合并症。
