Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China; TianLin Community Health Center, Shanghai, China.
J Ren Nutr. 2021 Jul;31(4):397-402. doi: 10.1053/j.jrn.2020.08.016. Epub 2020 Dec 10.
To investigate the association of sarcopenia and its components (muscle mass, muscle strength, and physical performance) with dependency in activities of daily living (ADLs) in maintaining patients on hemodialysis.
This is a cross-sectional study. Sarcopenia was identified according to the Asian Working Group for Sarcopenia 2019 criteria. Basic ADLs (BADLs) and instrumental ADLs (IADLs) were assessed. Logistic regression was used to estimate the association of sarcopenia and its components with dependency. Area under the receiver-operating characteristic curve of gait speed corresponding with dependency was calculated.
A total of 238 patients on hemodialysis were included. The proportion of enrolled male candidates was 67.6%, and the average age was 60.9 years. In all, 49.2% (n = 117) and 30.7% (n = 73) of patients on dialysis were diagnosed with sarcopenia and severe sarcopenia, respectively. Dependency in BADLs was 21.0% (n = 50), and dependency in IADLs was 41.2% (n = 98). Severe sarcopenia was significantly associated with dependency in BADLs and IADLs after adjustment of clinical covariables (odds ratio [OR], 4.68 [95% confidence interval (CI): 2.11-10.40]; OR, 3.24 [95% CI: 1.61-6.53], respectively), whereas those effects for sarcopenia were not significant. With all three sarcopenia components in the analysis model, high gait speed remained strongly associated with low function dependency in BADLs and IADLs (per 0.1 m/s increase of gait speed: OR, 0.52 [95% CI: 0.41-0.66]; and 0.46 [95% CI: 0.35-0.59], respectively). Area under the receiver-operating characteristic curve of gait speed corresponding with dependency in BADLs and IADLs was 0.827 (0.759, 0.896) and 0.878 (0.832, 0.925), respectively.
Severe sarcopenia was closely related to dependency in ADL in patients on hemodialysis. Gait speed was the most important factor affecting dependency in sarcopenia and had good diagnostic accuracy for screening dependency in ADL.
探讨肌少症及其组成部分（肌肉质量、肌肉力量和身体表现）与维持血液透析患者日常生活活动（ADL）依赖的关系。
这是一项横断面研究。根据 2019 年亚洲工作组肌少症标准确定肌少症。评估基本日常生活活动（BADLs）和工具性日常生活活动（IADLs）。使用逻辑回归估计肌少症及其组成部分与依赖的关系。计算与依赖相对应的步态速度的受试者工作特征曲线下面积。
共纳入 238 名血液透析患者。入选男性候选人的比例为 67.6%，平均年龄为 60.9 岁。共有 49.2%（n=117）和 30.7%（n=73）的透析患者被诊断为肌少症和严重肌少症。BADLs 的依赖率为 21.0%（n=50），IADLs 的依赖率为 41.2%（n=98）。严重肌少症与 BADLs 和 IADLs 的依赖显著相关，调整临床协变量后（比值比[OR]，4.68[95%置信区间（CI）：2.11-10.40]；OR，3.24[95%CI：1.61-6.53]），而肌少症的影响不显著。在分析模型中包含所有三种肌少症成分时，高步速仍与 BADLs 和 IADLs 的低功能依赖密切相关（步速每增加 0.1m/s：OR，0.52[95%CI：0.41-0.66]；和 0.46[95%CI：0.35-0.59]）。与 BADLs 和 IADLs 依赖相对应的步态速度的受试者工作特征曲线下面积分别为 0.827（0.759，0.896）和 0.878（0.832，0.925）。
严重肌少症与血液透析患者 ADL 依赖密切相关。步速是影响肌少症依赖的最重要因素，对筛查 ADL 依赖具有良好的诊断准确性。
