Geriatric Unit, Internal Medicine Department, Hospital Universitari de Bellvitge, Systemic Diseases and Ageing Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
Hestia Chair in Integrated Health and Social Care, Faculty of Medicine and Health Sciences, Catalunya International University, Barcelona, Spain.
BMC Geriatr. 2020 Oct 2;20(Suppl 1):327. doi: 10.1186/s12877-020-01700-x.
BACKGROUND: Loss of muscle mass and function may be more pronounced in older adults with chronic kidney disease (CKD) and with albuminuria. Thus, we investigated the prevalence of sarcopenia among community-dwelling older adults according to kidney function and grade of albuminuria. We also explored differences in the prevalence of sarcopenia according to three different equations for the estimation of glomerular filtration rate (eGFR). METHODS: A cross-sectional analysis of 1420 community-dwelling older adults (≥75 years old) included in the SCOPE study, a multicenter prospective cohort study, was conducted. Comprehensive geriatric assessment including short physical performance battery (SPPB), handgrip strength test and bioelectrical impedance analysis (BIA) was performed. Sarcopenia was defined using the updated criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2). eGFR was calculated using Berlin Initiative Study (BIS), Chronic Kidney Disease Epidemiological Collaboration (CKD-EPI) and Full Age Spectrum (FAS) equations, and urinary albumin-to-creatinine ratio (ACR) was collected to categorize CKD according to Kidney Disease Improving Global Outcomes guidelines. RESULTS: Median age was 79.5 years (77.0-83.0), 804 (56.6%) were women. Using EWGSOP2 definition, 150 (10.6%) participants met diagnostic criteria for sarcopenia. Moreover, 85 (6%) participants had severe sarcopenia. Sarcopenia was more prevalent in participants with more advanced stages of CKD according to BIS eq. (9.6% in stages 1 and 2 and 13.9% in stages 3a, 3b and 4, p = 0.042), and also according to CKD-EPI (9.8% vs. 14.2%, p = 0.042) and FAS although not reaching statistical signification (9.8% vs. 12.7%, p = 0.119). Thus, differences in prevalence are observed among CKD categories as estimated by different equations. Prevalence of sarcopenia was also higher with increasing albuminuria categories: 9.3% in normoalbuminuric, 13.2% in microalbuminuric and 16.8% in macroalbuminuric participants, (p = 0.019). CONCLUSIONS: Sarcopenia is common among community-dwelling older adults, especially among those with more advanced CKD categories, with prevalence estimates differing slightly depending on the equation used for the estimation of eGFR; as well as among those with higher albuminuria categories.
背景：肌肉减少症和功能丧失在患有慢性肾脏病（CKD）和白蛋白尿的老年患者中可能更为明显。因此，我们根据肾功能和白蛋白尿程度，研究了社区居住的老年人中肌少症的患病率。我们还根据三种不同的肾小球滤过率（eGFR）估计方程，探讨了肌少症患病率的差异。
方法：对 SCOPE 研究的 1420 名社区居住的老年人（≥75 岁）进行了横断面分析，该研究是一项多中心前瞻性队列研究。进行了全面的老年评估，包括短体功能力表（SPPB）、握力测试和生物电阻抗分析（BIA）。使用欧洲老年人肌少症工作组（EWGSOP2）的更新标准定义肌少症。使用柏林倡议研究（BIS）、慢性肾脏病流行病学合作研究（CKD-EPI）和全年龄谱（FAS）方程计算 eGFR，并收集尿白蛋白与肌酐比值（ACR），根据肾脏病改善全球结局指南对 CKD 进行分类。
结果：中位年龄为 79.5 岁（77.0-83.0），804 名（56.6%）为女性。根据 EWGSOP2 定义，150 名（10.6%）参与者符合肌少症的诊断标准。此外，85 名（6%）参与者患有严重的肌少症。根据 BIS eq，肌少症在 CKD 分期较晚的患者中更为常见（1 期和 2 期为 9.6%，3a、3b 和 4 期为 13.9%，p=0.042），根据 CKD-EPI（9.8%比 14.2%，p=0.042）和 FAS 也更为常见（9.8%比 12.7%，p=0.119），尽管未达到统计学显著性。因此，不同方程估计的 CKD 类别之间存在患病率差异。随着白蛋白尿类别的增加，肌少症的患病率也升高：正常白蛋白尿者为 9.3%，微量白蛋白尿者为 13.2%，大量白蛋白尿者为 16.8%（p=0.019）。
结论：肌少症在社区居住的老年人中很常见，尤其是在 CKD 分期较晚的患者中，根据用于估计 eGFR 的方程不同，患病率估计值略有差异；在白蛋白尿水平较高的患者中也是如此。
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