McKeaveney Clare, Slee Adrian, Adamson Gary, Davenport Andrew, Farrington Ken, Fouque Denis, Kalantar-Zadeh Kamyar, Mallett John, Maxwell Alexander P, Mullan Robert, Noble Helen, O'Donoghue Donal, Porter Sam, Seres David S, Shields Joanne, Witham Miles, Reid Joanne
School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK.
Division of Medicine, Faculty of Medical Sciences, University College London, London, UK.
Nephrol Dial Transplant. 2021 Sep 27;36(10):1919-1926. doi: 10.1093/ndt/gfaa174.
Research indicates that cachexia is common among persons with chronic illnesses and is associated with increased morbidity and mortality. However, there continues to be an absence of a uniformed disease-specific definition for cachexia in chronic kidney disease (CKD) patient populations.
The primary objective was to identify cachexia in patients receiving haemodialysis (HD) using a generic definition and then follow up on these patients for 12 months.
This was a longitudinal study of adult chronic HD patients attending two hospital HD units in the UK. Multiple measures relevant to cachexia, including body mass index (BMI), muscle mass [mid-upper arm muscle circumference (MUAMC)], handgrip strength (HGS), fatigue [Functional Assessment of Chronic Illness Therapy (FACIT)], appetite [Functional Assessment of Anorexia/Cachexia Therapy (FAACT)] and biomarkers [C-reactive protein (CRP), serum albumin, haemoglobin and erythropoietin resistance index (ERI)] were recorded. Baseline analysis included group differences analysed using an independent t-test, dichotomized values using the χ2 test and prevalence were reported using the Statistical Package for the Social Sciences 24 (IBM, Armonk, NY, USA). Longitudinal analysis was conducted using repeated measures analysis.
A total of 106 patients (30 females and 76 males) were recruited with a mean age of 67.6 years [standard deviation (SD) 13.18] and dialysis vintage of 4.92 years (SD 6.12). At baseline, 17 patients were identified as cachectic, having had reported weight loss (e.g. >5% for >6 months) or BMI <20 kg/m2 and three or more clinical characteristics of cachexia. Seventy patients were available for analysis at 12 months (11 cachectic versus 59 not cachectic). FAACT and urea reduction ratio statistically distinguished cachectic patients (P = 0.001). However, measures of weight, BMI, MUAMC, HGS, CRP, ERI and FACIT tended to worsen in cachectic patients.
Globally, cachexia is a severe but frequently underrecognized problem. This is the first study to apply the defined characteristics of cachexia to a representative sample of patients receiving HD. Further, more extensive studies are required to establish a phenotype of cachexia in advanced CKD.
研究表明，恶病质在慢性病患者中很常见，且与发病率和死亡率增加相关。然而，在慢性肾脏病（CKD）患者群体中，对于恶病质仍缺乏统一的、针对特定疾病的定义。
主要目的是使用通用定义识别接受血液透析（HD）的患者中的恶病质，然后对这些患者进行为期12个月的随访。
这是一项针对英国两家医院血液透析科室成年慢性HD患者的纵向研究。记录了与恶病质相关的多项指标，包括体重指数（BMI）、肌肉量[上臂中部肌肉周长（MUAMC）]、握力（HGS）、疲劳[慢性病治疗功能评估（FACIT）]、食欲[厌食/恶病质治疗功能评估（FAACT）]以及生物标志物[C反应蛋白（CRP）、血清白蛋白、血红蛋白和促红细胞生成素抵抗指数（ERI）]。基线分析包括使用独立t检验分析组间差异，使用χ2检验分析二分变量值，并使用社会科学统计软件包24（IBM，美国纽约州阿蒙克）报告患病率。纵向分析采用重复测量分析。
共招募了106例患者（30例女性和76例男性），平均年龄为67.6岁[标准差（SD）13.18]，透析龄为4.92年（SD 6.12）。在基线时，17例患者被确定为恶病质，报告有体重减轻（如6个月内体重减轻>5%）或BMI<20 kg/m2且具有三种或更多恶病质临床特征。70例患者在12个月时可进行分析（11例恶病质患者与59例非恶病质患者）。FAACT和尿素清除率在统计学上可区分恶病质患者（P = 0.001）。然而，恶病质患者的体重、BMI、MUAMC、HGS、CRP、ERI和FACIT指标往往会恶化。
在全球范围内，恶病质是一个严重但经常未被认识到的问题。这是第一项将恶病质的定义特征应用于接受HD的代表性患者样本的研究。此外，需要进行更广泛的研究来确定晚期CKD中恶病质的表型。
