Division of Geriatrics, Department of Medicine, University of Verona, Verona, Italy.
Renal Unit, Department of Medicine, University of Verona, Verona, Italy.
J Nephrol. 2018 Aug;31(4):613-620. doi: 10.1007/s40620-018-0483-5. Epub 2018 Mar 17.
Renal transplant (RTX) recipients seem to experience a better quality of life compared to dialysis patients. However, the factors responsible for this positive effect are not completely defined. Conceivably, a change in the physical performance of these patients could play a role.
To assess this, we measured: (1) waist circumference, fat mass and appendicular fat-free mass (aFFM) by dual-energy X-ray densitometry, (2) physical performance with the Short Physical Performance Battery, and (3) muscle strength with the handgrip test, in 59 male RTX, 11 chronic kidney disease in conservative treatment (CKD) and 10 peritoneal dialysis (PD) patients.
Surprisingly, anthropometric characteristics and body composition were similar among the three groups. However, despite a low aFFM, muscle strength was higher in stable RTX recipients > 5 years after transplantation than in dialyzed patients. Instead, CKD (wait-listed for RTX) had similar muscle strength to RTX patients. Waist circumference in RTX recipients showed a redistribution of body fat with increased central adipose tissue allocation compared to PD. At linear regression analysis, age, weight, height, aFFM, hemoglobin and transplant age were independent predictors of handgrip strength, explaining about 37% of the variance. Age and transplant age accounted for 18 and 12% of variance, respectively.
Our study demonstrates, for the first time, that clinically stable RTX recipients have greater muscle strength than dialyzed patients and suggests that the handgrip test could be an effective and easy-to-perform tool to assess changes in physical performance in this large patient population.
与透析患者相比，肾移植（RTX）受者的生活质量似乎更好。然而，导致这种积极影响的因素尚未完全确定。可以想象，这些患者的身体表现的变化可能起作用。
为了评估这一点，我们通过双能 X 射线吸收法测量了：（1）腰围、体脂肪量和四肢去脂体质量（aFFM），（2）使用短体适能电池测量身体表现，以及（3）使用握力测试测量肌肉力量，共纳入 59 名男性 RTX 受者、11 名保守治疗的慢性肾脏病（CKD）患者和 10 名腹膜透析（PD）患者。
令人惊讶的是，三组患者的人体测量特征和身体成分相似。然而，尽管 aFFM 较低，但稳定的 RTX 受者在移植后 5 年以上的肌肉力量仍高于透析患者。相反，等待 RTX 移植的 CKD（等待名单）患者的肌肉力量与 RTX 患者相似。RTX 受者的腰围表现出身体脂肪的重新分布，与 PD 患者相比，中央脂肪组织分配增加。在线性回归分析中，年龄、体重、身高、aFFM、血红蛋白和移植年龄是握力的独立预测因素，可解释约 37%的方差。年龄和移植年龄分别占方差的 18%和 12%。
我们的研究首次表明，临床稳定的 RTX 受者的肌肉力量大于透析患者，并表明握力测试可能是评估该大型患者人群身体表现变化的有效且易于实施的工具。
