Division of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
Department of Public Health, Tzu Chi University, Hualien, Taiwan.
BMC Nephrol. 2019 Feb 14;20(1):54. doi: 10.1186/s12882-019-1223-3.
Sarcopenia, defined as low muscle mass and strength, is highly prevalent in patients undergoing chronic hemodialysis (HD). However, muscle function and muscle mass do not share the same clinical relevance. In fact, muscle strength was more closely associated with the risk of mortality in chronic HD patients than was muscle mass. Therefore, to identify the risk factors of muscle weakness is vital. Angiotensin II overexpression had been recognized to impair skeletal muscle strength. Accordingly, angiotensin II receptor blockers (ARBs) potentially possess a muscle protective effect. This cross-sectional study aimed to identify the factors associated with low muscle strength and to explore the relationship between ARB use and muscle strength in chronic HD patients.
A total of 120 chronic HD patients, aged 63.3 ± 13.2 years, were included in this study. Basic characteristics, handgrip strength (HGS), body composition, and nutritional status were assessed, and blood samples for biochemical tests were obtained. We divided these participants into normal- and low HGS groups according to the consensus of the European Working Group on Sarcopenia in Older People (EWGSOP).
We observed that 78 (65.0%) patients had low HGS. In our cohort, we found that height (r = 0.653; P < 0.001), weight (r = 0.496; P < 0.001), body mass index (r = 0.215; P = 0.020), skeletal muscle index (r = 0.562; P < 0.001), albumin (r = 0.197; P = 0.032), and serum creatinine (r = 0.544; P < 0.001) were positively and age (r = - 0.506; P < 0.001), subjective global assessment (SGA) score (r = - 0.392; P < 0.001), fractional clearance index for urea (Kt/V) (r = - 0.404; P < 0.001) and urea reduction ratio (URR) (r = - 0.459; P < 0.001) were negatively correlated with HGS. According to our analysis, age (Odds ratio, OR = 1.11, 95% confidence interval, 95% CI = 1.05-1.17, P < 0.001), HD duration (OR = 1.01, 95% CI = 1.00-1.02, P = 0.010), diabetes (OR = 13.33, 95% CI = 3.45-51.53, P < 0.001), Kt/V (OR = 1.61, 95% CI = 1.06-2.46, P = 0.027), and SGA score (OR = 1.19, 95% CI = 1.03-1.38, P = 0.017) were regarded as independent predictors of low HGS. In contrast, ARB use (OR = 0.25, 95% CI = 0.07-0.93, P = 0.039) was independently associated with preserved HGS in chronic HD patients, after adjustment for multiple confounding factors.
Our study is the first report in chronic HD patients to indicate a potentially protective effect of ARB on muscle strength. However, further longitudinal follow-up and intervention studies are needed to confirm this finding.
肌肉减少症定义为肌肉量和力量低，在接受慢性血液透析（HD）的患者中非常普遍。然而，肌肉功能和肌肉量没有相同的临床相关性。事实上，肌肉力量与慢性 HD 患者的死亡率比肌肉量更密切相关。因此，确定肌肉无力的危险因素至关重要。血管紧张素 II 的过表达已被认为会损害骨骼肌力量。因此，血管紧张素 II 受体阻滞剂（ARB）可能具有肌肉保护作用。这项横断面研究旨在确定与肌肉无力相关的因素，并探讨慢性 HD 患者中 ARB 使用与肌肉力量之间的关系。
本研究纳入了 120 名年龄为 63.3±13.2 岁的慢性 HD 患者。评估了他们的基本特征、握力（HGS）、身体成分和营养状况，并采集了生化检测的血液样本。我们根据欧洲老年人肌肉减少症工作组（EWGSOP）的共识，将这些参与者分为正常握力组和低握力组。
我们发现 78 名（65.0%）患者的 HGS 较低。在我们的队列中，我们发现身高（r=0.653；P<0.001）、体重（r=0.496；P<0.001）、体重指数（r=0.215；P=0.020）、骨骼肌指数（r=0.562；P<0.001）、白蛋白（r=0.197；P=0.032）和血清肌酐（r=0.544；P<0.001）与 HGS 呈正相关，而年龄（r=-0.506；P<0.001）、主观整体评估（SGA）评分（r=-0.392；P<0.001）、尿素分数清除指数（Kt/V）（r=-0.404；P<0.001）和尿素降低率（URR）（r=-0.459；P<0.001）与 HGS 呈负相关。根据我们的分析，年龄（优势比，OR=1.11，95%置信区间，95%CI=1.05-1.17，P<0.001）、HD 持续时间（OR=1.01，95%CI=1.00-1.02，P=0.010）、糖尿病（OR=13.33，95%CI=3.45-51.53，P<0.001）、Kt/V（OR=1.61，95%CI=1.06-2.46，P=0.027）和 SGA 评分（OR=1.19，95%CI=1.03-1.38，P=0.017）被认为是低 HGS 的独立预测因素。相反，ARB 使用（OR=0.25，95%CI=0.07-0.93，P=0.039）与慢性 HD 患者的 HGS 保持独立相关，在调整了多个混杂因素后。
我们的研究是第一项在慢性 HD 患者中表明 ARB 对肌肉力量具有潜在保护作用的报告。然而，需要进一步的纵向随访和干预研究来证实这一发现。
