Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea.
PLoS One. 2019 Apr 4;14(4):e0214912. doi: 10.1371/journal.pone.0214912. eCollection 2019.
Autosomal dominant polycystic kidney disease (ADPKD) patients with massive organomegaly suffer from pressure-related complications including malnutrition. In this study, we analyzed the efficacy of segmental bioelectrical impedance analysis (BIA) for objective and quantitative nutritional assessment in ADPKD patients.
We conducted a cross-sectional study, to evaluate the clinical utility of segmental BIA for assessing the nutritional status of ADPKD patients. BIA measurements was assessed according to modified subjective global assessment (SGA) scores and were compared with data from a healthy population. The association between BIA measurements and the height adjusted kidney and liver volumes (htTKLV), were analyzed.
A total of 288 ADPKD patients, aged ≥ 18 years old, were analyzed.
Nutritional status was evaluated with SGA and segmental BIA. The htTKLV were measured in each patients using computed tomonography images.
Higher ratios of extracellular water to total body water (ECW/TBW) in the whole-body (ECW/TBWWB), trunk (ECW/TBWTR), and lower extremities (ECW/TBWLE) and lower phase angle of lower extremities (PhALE) correlated with lower SGA scores in the ADPKD population and in both gender. The four parameters, ECW/TBWWB, ECW/TBWTR, and ECW/TBWLE of >0.38 and PhALE of <5.8 θ were associated with malnutrition in ADPKD patients. These correlations were preserved in the subgroup analysis for chronic kidney disease stages 1-3A. Compared to healthy populations' data, body fluid parameters and segmental ECW/TBW values, except for the upper extremities (ECW/TBWUE), were greater in ADPKD patients. Increased htTKLV was an independent risk factor for malnutrition in ADPKD. The highest correlation with htTKLV was observed for the ECW/TBWTR (r = 0.466), followed by ECW/TBWWB (r = 0.407), ECW/TBWLE (r = 0.385), PhALE (r = -0.279), and PhATR (r = 0.215).
These results demonstrated that segmental BIA parameters of ECW/TBWWB, ECW/TBWTR, ECW/TBWLE and PhALE provide useful information on nutritional status including the impact of organomegaly in ADPKD.
常染色体显性多囊肾病（ADPKD）患者存在器官肿大，易发生与压力相关的并发症，包括营养不良。本研究旨在分析节段生物电阻抗分析（BIA）在 ADPKD 患者中进行客观定量营养评估的效果。
本研究采用横断面研究，评估节段 BIA 评估 ADPKD 患者营养状况的临床应用价值。根据改良主观全面评估（SGA）评分评估 BIA 测量值，并与健康人群的数据进行比较。分析 BIA 测量值与身高校正的肾脏和肝脏体积（htTKLV）之间的关系。
共分析了 288 例年龄≥18 岁的 ADPKD 患者。
采用 SGA 和节段 BIA 评估营养状况。使用计算机断层扫描图像测量每位患者的 htTKLV。
全身性（ECW/TBWWB）、躯干（ECW/TBWTR）和下肢（ECW/TBWLE）的细胞外水与总体水的比值（ECW/TBW）以及下肢的相位角（PhALE）较高，与 ADPKD 患者和两性患者的 SGA 评分较低相关。ECW/TBWWB、ECW/TBWTR 和 ECW/TBWLE ＞0.38 以及 PhALE ＜5.8θ 这四个参数与 ADPKD 患者的营养不良相关。在慢性肾脏病 1-3A 期亚组分析中，这些相关性仍然存在。与健康人群的数据相比，ADPKD 患者的体液参数和节段性 ECW/TBW 值（上肢除外）均较高。增加的 htTKLV 是 ADPKD 患者发生营养不良的独立危险因素。与 htTKLV 相关性最高的是 ECW/TBWTR（r = 0.466），其次是 ECW/TBWWB（r = 0.407）、ECW/TBWLE（r = 0.385）、PhALE（r = -0.279）和 PhATR（r = 0.215）。
这些结果表明，ECW/TBWWB、ECW/TBWTR、ECW/TBWLE 和 PhALE 等节段 BIA 参数可提供有关营养状况的有用信息，包括 ADPKD 患者的器官肿大影响。
