Department of Biochemistry, University Hospital of Montpellier, University of Montpellier, Montpellier, France.
PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France.
Nephrol Dial Transplant. 2021 Sep 27;36(10):1908-1918. doi: 10.1093/ndt/gfaa353.
Sarcopaenia, defined as a decline in both muscle mass and function, has been recognized as a major determinant of poor outcome in haemodialysis (HD) patients. It is generally assumed that sarcopaenia is driven by muscle atrophy related to protein-energy wasting. However, dynapaenia, defined as weakness without atrophy, has been characterized by a different disease phenotype from sarcopaenia. The aim of this study was to compare the characteristics and prognosis of sarcopaenic and dynapaenic patients among a prospective cohort of chronic HD (CHD) patients.
Two hundred and thirty-two CHD patients were enrolled from January to July 2016 and then followed prospectively until December 2018. At inclusion, weakness and atrophy were, respectively, evaluated by maximal voluntary force (MVF) and creatinine index (CI). Sarcopaenia was defined as the association of weakness and atrophy (MVF and CI below the median) while dynapaenia was defined as weakness not related to atrophy (MVF below the median, and CI above the median).
From a total of 187 prevalent CHD patients [65% of men, age 65.3 (49.7-82.0) years], 44 died during the follow-up period of 23.7 (12.4-34.9) months. Sarcopaenia and dynapaenia were observed in 33.7 and 16% of the patients, respectively. Compared with patients with sarcopaenia, patients with dynapaenia were younger and with a lower Charlson score. In contrast, mortality rate was similar in both groups (38 and 27%, respectively). After adjustment for age, sex, lean tissue index, serum albumin, high-sensitivity C-reactive protein (hs-CRP), haemoglobin (Hb), normalized protein catabolic rate (nPCR), dialysis vintage and Charlson score, only patients with dynapaenia were at increased risk of death [hazard ratio (HR) = 2.99, confidence interval 1.18-7.61; P = 0.02].
Screening for muscle functionality is highly warranted to identify patients with muscle functional impairment without muscle atrophy. In contrast to sarcopaenia, dynapaenia should appear as a phenotype induced by uraemic milieu, characterized by young patients with low Charlson score and poor prognosis outcome independently of serum albumin, hs-CRP, Hb, nPCR and dialysis vintage.
肌肉减少症定义为肌肉质量和功能的下降，已被认为是血液透析（HD）患者预后不良的主要决定因素。通常认为，肌肉减少症是由与蛋白质能量消耗相关的肌肉萎缩引起的。然而，动力减少症，定义为无萎缩的虚弱，其疾病表型与肌肉减少症不同。本研究的目的是比较前瞻性慢性 HD（CHD）患者队列中肌肉减少症和动力减少症患者的特征和预后。
2016 年 1 月至 7 月期间，纳入了 232 名 CHD 患者，并前瞻性随访至 2018 年 12 月。纳入时，通过最大自主力（MVF）和肌酸指数（CI）分别评估虚弱和萎缩。肌肉减少症定义为虚弱和萎缩的联合（MVF 和 CI 低于中位数），而动力减少症定义为与萎缩无关的虚弱（MVF 低于中位数，CI 高于中位数）。
在总共 187 名现患 CHD 患者中（65%为男性，年龄 65.3（49.7-82.0）岁），44 名患者在 23.7（12.4-34.9）个月的随访期间死亡。33.7%和 16%的患者分别存在肌肉减少症和动力减少症。与肌肉减少症患者相比，动力减少症患者更年轻，Charlson 评分更低。然而，两组的死亡率相似（分别为 38%和 27%）。在校正年龄、性别、瘦组织指数、血清白蛋白、高敏 C 反应蛋白（hs-CRP）、血红蛋白（Hb）、标准化蛋白分解率（nPCR）、透析年限和 Charlson 评分后，只有动力减少症患者的死亡风险增加[风险比（HR）=2.99，95%置信区间 1.18-7.61；P=0.02]。
筛查肌肉功能对于识别无肌肉萎缩的肌肉功能受损患者非常重要。与肌肉减少症不同，动力减少症应表现为一种由尿毒症环境引起的表型，其特征是年轻患者、Charlson 评分低、预后不良，与血清白蛋白、hs-CRP、Hb、nPCR 和透析年限无关。
