Division of Nephrology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, 431-070, Republic of Korea.
Hallym University Kidney Research Institute, Anyang, Republic of Korea.
BMC Nephrol. 2020 Jul 16;21(1):281. doi: 10.1186/s12882-020-01937-z.
Increased oxidative stress in end-stage renal disease is regarded as one of the important mechanisms in the atherosclerosis and muscle wasting. However, studies examining the clinical significance of oxidative stress by direct measurement of these markers and its association with volume status and sarcopenia are limited.
A follow-up cross-sectional study was performed in stable hemodialysis (HD) patients and serum protein carbonyl levels were measured as a biomarker of oxidative stress. Additionally, multi-frequency body composition analysis, handgrip strength (HGS) and nutritional assessments were performed at baseline.
Eighty-eight patients undergoing HD were included and 30 (34.1%) patients died during a mean follow-up of 5.2 years. The mean patient age was 60.6 ± 13.5 years, and the mean HD duration was 50.8 ± 41.3 months. In total, 16 patients (18.2%) were overhydrated, 49 (55.7%) had low HGS and 36 (40.9%) had low muscle mass. Serum protein carbonyl levels were associated with serum levels of albumin, prealbumin and transferrin, hydration status and low HGS. Overhydration (odds ratio [OR] 7.01, 95% CI 1.77-27.79, p = 0.006), prealbumin (OR 0.91, 95% CI 0.83-0.99, p = 0.030), subjective global assessment (OR 3.52, 95% CI 1.08-11.46, p = 0.037) and sarcopenia (OR 3.41, 95% CI 1.02-11.32, p = 0.046) were significantly related to increased serum protein carbonyl levels. Multivariate analysis showed that the serum levels of protein carbonyl (Hazard ratio [HR] 2.37, 95% CI 1.02-5.55, p = 0.036), albumin (HR 0.17, 95% CI 0.06-0.46, p = 0.003), prealbumin (HR 0.86, 95% CI 0.80-0.92, p = 0.001), overhydration (HR 2.31, 95% CI 1.26-8.71, p = 0.015) and sarcopenia (HR 2.72, 95% CI 1.11-6.63, p = 0.028) were independent determinants of all-cause mortality.
Serum protein carbonyl was significantly associated with overhydration, nutritional status and sarcopenia, and could be a new predictor of mortality in patients undergoing HD.
终末期肾病患者的氧化应激增加被认为是动脉粥样硬化和肌肉减少的重要机制之一。然而，通过直接测量这些标志物来检查氧化应激的临床意义及其与容量状态和肌肉减少症的关系的研究是有限的。
对稳定的血液透析（HD）患者进行随访横断面研究，并测量血清蛋白羰基水平作为氧化应激的生物标志物。此外，在基线时进行了多频身体成分分析、握力（HGS）和营养评估。
共纳入 88 例接受 HD 的患者，其中 30 例（34.1%）患者在平均 5.2 年的随访期间死亡。患者平均年龄为 60.6±13.5 岁，HD 平均持续时间为 50.8±41.3 个月。共有 16 例（18.2%）患者存在水过多，49 例（55.7%）握力较低，36 例（40.9%）肌肉量低。血清蛋白羰基水平与血清白蛋白、前白蛋白和转铁蛋白水平、水合状态和低握力有关。水过多（优势比[OR]7.01，95%置信区间 1.77-27.79，p=0.006）、前白蛋白（OR 0.91，95%置信区间 0.83-0.99，p=0.030）、主观整体评估（OR 3.52，95%置信区间 1.08-11.46，p=0.037）和肌肉减少症（OR 3.41，95%置信区间 1.02-11.32，p=0.046）与血清蛋白羰基水平升高显著相关。多变量分析显示，血清蛋白羰基（危险比[HR]2.37，95%置信区间 1.02-5.55，p=0.036）、白蛋白（HR 0.17，95%置信区间 0.06-0.46，p=0.003）、前白蛋白（HR 0.86，95%置信区间 0.80-0.92，p=0.001）、水过多（HR 2.31，95%置信区间 1.26-8.71，p=0.015）和肌肉减少症（HR 2.72，95%置信区间 1.11-6.63，p=0.028）是全因死亡率的独立决定因素。
血清蛋白羰基与水过多、营养状况和肌肉减少症显著相关，可能是血液透析患者死亡率的一个新预测指标。
