Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil.
Nutrition Graduation Program and Nephrology Division, Federal University of São Paulo, São Paulo, Brazil.
J Ren Nutr. 2018 May;28(3):197-207. doi: 10.1053/j.jrn.2017.12.003.
This study aimed to assess whether diminished muscle mass, diminished muscle strength, or both conditions (sarcopenia) are associated with worse nutritional status, poor quality of life (QoL), and hard outcomes, such as hospitalization and mortality, in elderly patients on maintenance hemodialysis (MHD).
This is a multicenter observational longitudinal study that included 170 patients on MHD (age 70 ± 7 years, 65% male) from 6 dialysis centers.
The European Working Group on Sarcopenia in Older People defines sarcopenia as the presence of both low muscle mass by appendicular skeletal + low muscle function by handgrip strength. This study evaluated the clinical and nutritional status (laboratory, anthropometry, dual-energy X-ray absorptiometry, 7-point subjective global assessment) and QoL (Kidney Disease Quality of Life) at baseline. Hospitalization and mortality were recorded during 36 months.
Reduced muscle mass was observed in 64% of the patients, reduced muscle strength in 52%, and sarcopenia in 37%. The group with sarcopenia was older, had a higher proportion of men and showed worse clinical and nutritional conditions when compared with patients without sarcopenia. Although reduced muscle mass was strongly associated with poor nutritional status, low muscle strength was associated with worse QoL domains. In the multivariate Cox analyses adjusted by age, gender, dialysis vintage, and diabetes mellitus, low muscle strength alone and sarcopenia were associated with higher hospitalization, and sarcopenia was a predictor of mortality.
In conclusion, in this sample, comprised of elderly patients on MHD, sarcopenia was associated with worse nutritional and clinical conditions and was a predictor of hospitalization and mortality.
本研究旨在评估肌肉减少症（肌肉质量和肌肉力量下降）或两种情况（肌少症）与老年维持性血液透析（MHD）患者的营养状况恶化、生活质量（QoL）下降以及住院和死亡等不良结局的关系。
这是一项多中心观察性纵向研究，纳入了来自 6 个透析中心的 170 名 MHD 患者（年龄 70±7 岁，65%为男性）。
欧洲老年人肌少症工作组将肌少症定义为四肢骨骼肌质量低+握力低的肌肉功能低。本研究在基线时评估了临床和营养状况（实验室、人体测量学、双能 X 射线吸收法、7 点总体主观评估）和 QoL（肾脏病生活质量）。在 36 个月期间记录了住院和死亡情况。
64%的患者存在肌肉减少症，52%的患者存在肌肉力量下降，37%的患者存在肌少症。肌少症组患者年龄较大，男性比例较高，与无肌少症的患者相比，临床和营养状况较差。虽然肌肉减少症与营养状况差密切相关，但肌肉力量下降与 QoL 较差的领域相关。在调整年龄、性别、透析年限和糖尿病后进行的多变量 Cox 分析中，仅肌肉力量下降和肌少症与更高的住院率相关，肌少症是死亡的预测因素。
总之，在本研究中，MHD 老年患者中肌少症与较差的营养和临床状况相关，并且是住院和死亡的预测因素。
