Acute and Chronic Renal Failure Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
Postgraduate School of Nephrology, Parma University, Parma, Italy.
Clin Nutr. 2019 Jun;38(3):1232-1239. doi: 10.1016/j.clnu.2018.05.004. Epub 2018 May 19.
BACKGROUND & AIMS: Protein-Energy Wasting (PEW) is a pathological condition of renal patients with advanced Chronic Kidney Disease characterized by a progressive reduction of energy and protein assets. Nutritional status assessment, especially for what concerns muscle mass, is essential for both the identification of patients at risk for the development of PEW, as well as monitoring the effects of nutritional interventions. Ultrasound methods are easily applicable at the bedside for quantitative assessment of skeletal muscle. The present study was aimed at evaluating quadriceps rectus femoris thickness (QRFT) and quadriceps vastus intermedius thickness (QVIT) in patients on chronic hemodialysis.
This was a prospective observational study. Three groups of adult patients were studied: young healthy subjects, well-nourished hospitalized patients with normal renal function, and End-Stage Renal Disease patients on hemodialysis (ESRD-HD). QRFT and QVIT were measured at two sites bilaterally (8 measures/patient) and were compared between groups, and also between subgroups of ESRD-HD patients stratified on the basis of conventional nutritional status parameters.
We enrolled 35 healthy subjects, 30 hospitalized patients, and 121 ESRD-HD patients on hemodialysis. QRFT and QVIT of ESRD patients on hemodialysis were lower than those of both control groups (P < 0.001). After stratifying ESRD patients into subgroups based on nutritional variable cut-offs commonly used to define PEW in this clinical setting (BMI [≥ 23 vs <23 kg/m], albumin [≥3.8 vs <3.8 g/dL]) and malnutrition inflammation score (MIS) status (<6 vs ≥6), QRFT and QVIT of patients with worse nutritional status were significantly lower than those of well-nourished ESRD-HD patients (P value range: <0.001 to <0.05).
Skeletal muscle ultrasound is a simple and easily applicable bedside technique in the dialysis units, and could represent an adequate tool for the identification of patients with reduced muscle mass.
蛋白能量消耗（PEW）是一种发生在慢性肾脏病（CKD）终末期患者中的病理性状态，其特征为能量和蛋白质储备逐渐减少。营养状况评估，尤其是肌肉质量，对于识别有发生 PEW 风险的患者以及监测营养干预效果至关重要。超声方法可方便地用于床旁对骨骼肌进行定量评估。本研究旨在评估慢性血液透析患者股四头肌直肌厚度（QRFT）和股四头肌中间肌厚度（QVIT）。
这是一项前瞻性观察性研究。研究了三组成年患者：年轻健康受试者、营养良好的住院肾功能正常患者和血液透析的终末期肾脏病（ESRD-HD）患者。在双侧各测量 2 个部位的 QRFT 和 QVIT（每个患者 8 个测量值），并在组间进行比较，还根据常规营养状况参数对 ESRD-HD 患者进行分层后，在亚组间进行比较。
我们纳入了 35 名健康受试者、30 名住院患者和 121 名血液透析的 ESRD-HD 患者。血液透析的 ESRD 患者的 QRFT 和 QVIT 均低于其他两组（P<0.001）。根据在该临床环境中常用于定义 PEW 的营养变量切点（BMI [≥23 与<23 kg/m]、白蛋白 [≥3.8 与<3.8 g/dL]）和营养不良炎症评分（MIS）状态（<6 与≥6）将 ESRD 患者分层为亚组后，营养状况较差患者的 QRFT 和 QVIT 明显低于营养良好的 ESRD-HD 患者（P 值范围：<0.001 至<0.05）。
骨骼肌超声是透析单位中一种简单且易于应用的床边技术，可作为识别肌肉量减少患者的一种合适工具。
