血液透析患者蛋白质能量消耗伴发的贫血、水过多和肌肉力量下降。

Anemia, overhydration, and lower muscle strength in hemodialysis patients with protein-energy wasting.

机构信息

Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.

Medica Sur Clinic & Foundation, Mexico City, Mexico.

出版信息

Hemodial Int. 2022 Jul;26(3):415-423. doi: 10.1111/hdi.13022. Epub 2022 May 15.

DOI:10.1111/hdi.13022

PMID:35570333

Abstract

INTRODUCTION

The protein-energy wasting (PEW) syndrome is a common complication in hemodialysis (HD) patients associated to morbidity and mortality. Our objective was to assess the prevalence of PEW and its association with erythropoietin resistance index (ERI) score, body composition by impedance, health-related quality of life, and muscle strength.

METHODS

In this cross-sectional, observational, multicenter study, we included data from 191 HD patients from three HD clinics located in Mexico City, Mexico. Clinical and biochemistry variables, body composition, handgrip strength, and the KDQOL-SF36 questionnaire were collected for each patient.

FINDINGS

Prevalence of PEW was 22% (n = 41/191), with a higher frequency in those with diabetes mellitus (59% vs. 49%, p = 0.04). Subjects with PEW had lower hemoglobin levels (9.5 + 1.6 g/dl vs. 10.3 + 1.7 g/dl; p = 0.005) and higher ERI scores (19.2 ± 11.2 vs. 15.6 ± 8.2; p = 0.04) compared with the non-PEW group. In analysis of body composition, PEW was associated to higher overhydration status (42.2 vs. 24.9 OH/kg; p = 0.009), higher extracellular water (263 ± 40 vs. 246 ± 32 ml/kg; p = 0.019), lower lean tissue index (12.2 ± 3.2 vs. 14.1 ± 3.7 ml/m ; p = 0.021), and lower fat tissue index (9.6 ± 5.7 vs. 12.3 ± 6.2 ml/m ; p = 0.043). Handgrip strength was lower in PEW patients (22.5 vs. 28.1 kg; p = 0.002). Finally, no significant differences were observed between groups in quality-of-life assessment.

DISCUSSION

In this study, PEW was associated to poor responsiveness to erythropoiesis-stimulating agents, lower muscle strength, and higher overhydration status due to the increase in extracellular water which replaced the loss of tissue. Nevertheless, quality-of-life assessment was not different in patients with PEW compared with those without this complication.

摘要

简介

蛋白能量消耗（PEW）综合征是血液透析（HD）患者常见的并发症，与发病率和死亡率相关。我们的目的是评估 PEW 的患病率及其与红细胞生成刺激剂抵抗指数（ERI）评分、通过阻抗评估的身体成分、健康相关生活质量和肌肉力量的关系。

方法

在这项横断面、观察性、多中心研究中，我们纳入了来自墨西哥城三家 HD 诊所的 191 名 HD 患者的数据。为每位患者收集了临床和生化变量、身体成分、握力和 KDQOL-SF36 问卷。

结果

PEW 的患病率为 22%（n=41/191），糖尿病患者的患病率更高（59% vs. 49%，p=0.04）。患有 PEW 的患者血红蛋白水平较低（9.5+1.6 g/dl vs. 10.3+1.7 g/dl；p=0.005），ERI 评分较高（19.2+11.2 vs. 15.6+8.2；p=0.04）与非 PEW 组相比。在身体成分分析中，与非 PEW 组相比，PEW 与更高的超水合状态（42.2 与 24.9 OH/kg；p=0.009）、更高的细胞外液（263+40 与 246+32 ml/kg；p=0.019）、更低的瘦组织指数（12.2+3.2 与 14.1+3.7 ml/m 2 ；p=0.021）和更低的脂肪组织指数（9.6+5.7 与 12.3+6.2 ml/m 2 ；p=0.043）有关。PEW 患者的握力较低（22.5 与 28.1 kg；p=0.002）。最后，两组间的生活质量评估无显著差异。