Almushayt Shatha J, Hussain Samia, Wilkinson Daniel J, Selby Nicholas M
Centre for Kidney Research and Innovation, School of Medicine, University of Nottingham, Derby, UK.
Centre of Excellence for Musculoskeletal Ageing Research, University of Nottingham, Derby, UK.
Kidney Int Rep. 2019 Dec 30;5(3):307-317. doi: 10.1016/j.ekir.2019.12.012. eCollection 2020 Mar.
The underlying mechanisms of skeletal muscle wasting in hemodialysis patients are complex. We performed a systematic review to summarize evidence on whether hemodialysis has acute effects on skeletal muscle perfusion, metabolism, and function.
The protocol was registered on PROSPERO (Registration number CRD42018103682). A systematic search was performed in MEDLINE, PubMed, Cochrane, Embase, Scopus, and Web of Science. Citation, reference list, and gray literature searches were also performed. Studies were selected in 2 stages: title and abstract review, then full-text review.
A total of 65 full-text articles were reviewed, and 14 studies were eligible for inclusion. No studies were identified that assessed muscle perfusion during dialysis. Two studies used near-infrared spectroscopy to indirectly measure skeletal muscle oxygen consumption, which increased during dialysis in 1 study but only in patients with diabetes in the second. Metabolism was examined in 9 studies. A number of acute metabolic changes were reported (e.g., caspase-3 activity, polyubiquitin, and interleukin-6 protein increased in response to hemodialysis) as was a net negative protein balance over the dialysis session. Three studies examining muscle function did not produce consistent findings.
Gaps remain in understanding the acute effects of hemodialysis on skeletal muscle, particularly for changes in perfusion and function, although there does appear to be an acute effect on muscle metabolism.
血液透析患者骨骼肌萎缩的潜在机制较为复杂。我们进行了一项系统综述，以总结关于血液透析是否对骨骼肌灌注、代谢和功能有急性影响的证据。
该方案已在国际前瞻性系统评价注册库（注册号CRD42018103682）注册。在MEDLINE、PubMed、Cochrane、Embase、Scopus和科学网进行了系统检索。还进行了引文、参考文献列表和灰色文献检索。研究分两个阶段进行筛选：标题和摘要评审，然后是全文评审。
共审查了65篇全文文章，14项研究符合纳入标准。未发现评估透析期间肌肉灌注的研究。两项研究使用近红外光谱间接测量骨骼肌氧消耗，其中一项研究显示透析期间氧消耗增加，而另一项研究仅在糖尿病患者中观察到这种情况。9项研究对代谢进行了检查。报告了一些急性代谢变化（例如，血液透析后半胱天冬酶 - 3活性、多聚泛素和白细胞介素 - 6蛋白增加）以及透析期间净负蛋白平衡。三项研究检查肌肉功能，但结果不一致。
在理解血液透析对骨骼肌的急性影响方面仍存在差距，特别是在灌注和功能变化方面，尽管血液透析似乎确实对肌肉代谢有急性影响。
