School of Medicine, Montpellier University, Montpellier, France.
Global Medical Office, Europe Middle East and Africa, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany.
Nephrol Dial Transplant. 2020 Dec 4;35(12):2161-2171. doi: 10.1093/ndt/gfaa098.
Protein-energy wasting, muscle mass (MM) loss and sarcopenia are highly prevalent and associated with poor outcome in haemodialysis (HD) patients. Monitoring of MM and/or muscle metabolism in HD patients is of paramount importance for timely detection of muscle loss and to intervene adequately. In this study we assessed the reliability and reproducibility of a simplified creatinine index (SCI) as a surrogate marker of MM and explored its predictive value on outcome.
We included all in-centre HD patients from 16 European countries with at least one SCI. The baseline period was defined as 30 days before and after the first multifrequency bioimpedance spectroscopy measurement; the subsequent 7 years constituted the follow-up. SCI was calculated by the Canaud equation. Multivariate Cox proportional hazards models were applied to assess the association of SCI with all-cause mortality. Using backward analysis, we explored the trends of SCI before death. Bland-Altman analysis was performed to analyse the agreement between estimated and measured MM.
We included 23 495 HD patients; 3662 were incident. Females and older patients have lower baseline SCI. Higher SCI was associated with a lower risk of mortality [hazard ratio 0.81 (95% confidence interval 0.79-0.82)]. SCI decline accelerated ∼5-7 months before death. Lean tissue index (LTI) estimated by SCI was correlated with measured LTI in both sexes (males: R2 = 0.94; females: R2 = 0.92; both P < 0.001). Bland-Altman analysis showed that measured LTI was 4.71 kg/m2 (±2 SD: -12.54-3.12) lower than estimated LTI.
SCI is a simple, easily obtainable and clinically relevant surrogate marker of MM in HD patients.
蛋白质-能量消耗、肌肉质量（MM）损失和肌肉减少症在血液透析（HD）患者中非常普遍，与不良预后相关。监测 HD 患者的 MM 和/或肌肉代谢对于及时发现肌肉损失并进行充分干预至关重要。在这项研究中，我们评估了简化肌酐指数（SCI）作为 MM 替代标志物的可靠性和可重复性，并探讨了其对预后的预测价值。
我们纳入了来自 16 个欧洲国家的所有中心血液透析患者，这些患者至少有一次 SCI。基线期定义为首次多频生物电阻抗谱测量前后 30 天；随后的 7 年构成了随访期。SCI 通过 Canaud 方程计算。应用多变量 Cox 比例风险模型评估 SCI 与全因死亡率的相关性。通过向后分析，我们探讨了死亡前 SCI 的趋势。Bland-Altman 分析用于分析估计 MM 和测量 MM 之间的一致性。
我们纳入了 23495 名 HD 患者；3662 例为新发患者。女性和老年患者的基线 SCI 较低。较高的 SCI 与较低的死亡率风险相关[风险比 0.81（95%置信区间 0.79-0.82）]。SCI 下降在死亡前约 5-7 个月加速。SCI 估计的瘦组织指数（LTI）与两性的实测 LTI 相关（男性：R2=0.94；女性：R2=0.92；均 P<0.001）。Bland-Altman 分析显示，实测 LTI 比估计 LTI 低 4.71kg/m2（±2SD：-12.54-3.12）。
SCI 是 HD 患者 MM 的一种简单、易于获得且具有临床相关性的替代标志物。
