Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, China; Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
J Ren Nutr. 2023 Mar;33(2):298-306. doi: 10.1053/j.jrn.2022.06.008. Epub 2022 Jul 2.
Chronic kidney disease (CKD) leads to metabolic and nutritional abnormalities including resistance to insulin-like growth factor-1 (IGF-1) action, and reduced muscle mass and strength. Low IGF-1 as well as low hand-grip muscle strength (HGS) are independent predictors of increased mortality in CKD patients.
In 685 patients (CKD Stage 3-5, median age 58 years; 62% men), baseline measurements of IGF-1, HGS, subjective global assessment (SGA), lean body mass index (LBMI), and metabolic and inflammatory biomarkers potentially linked to IGF-1 were analyzed in relation to mortality during 5 years of follow-up. We compared survival in 4 groups with high or low (cut-offs defined by receiver operating characteristic curve analysis) levels of IGF-1 and HGS.
Patients with low IGF-1 were older; had lower BMI, HGS, and LBMI, were more likely to have diabetes, cardiovascular disease (CVD), and malnutrition (SGA >1); and had high-sensitivity C-reactive protein levels. During 5 years of follow-up, 208 patients died. The mortality rate was highest among patients with Low IGF-1 + Low HGS. In competing-risk regression analysis, Low IGF-1 + Low HGS was independently associated with 2.8 times higher all-cause mortality risk than Low IGF-1 + High HGS, after adjusting for Framingham's CVD risk score, presence of CVD, SGA, dialysis status, high-sensitivity C-reactive protein, albumin, LBMI, and sample time in freezer.
Low IGF-1 was associated with increased all-cause mortality in patients who also had low HGS but not in those with high HGS, suggesting that the association of IGF-1 with survival in CKD patients depends on nutritional status.
慢性肾脏病（CKD）导致代谢和营养异常，包括对胰岛素样生长因子-1（IGF-1）作用的抵抗以及肌肉质量和力量下降。低 IGF-1 以及低握力（HGS）是 CKD 患者死亡风险增加的独立预测因子。
在 685 名患者（CKD 3-5 期，中位年龄 58 岁；62%为男性）中，分析了 IGF-1、HGS、主观全面评估（SGA）、瘦体重指数（LBMI）以及可能与 IGF-1 相关的代谢和炎症生物标志物的基线测量值与 5 年随访期间的死亡率之间的关系。我们比较了 IGF-1 和 HGS 水平较高或较低（通过接受者操作特征曲线分析定义的截定点）的 4 组患者的生存情况。
低 IGF-1 患者年龄较大；BMI、HGS 和 LBMI 较低，更有可能患有糖尿病、心血管疾病（CVD）和营养不良（SGA>1）；且高敏 C 反应蛋白水平较高。在 5 年的随访期间，有 208 名患者死亡。低 IGF-1+低 HGS 患者的死亡率最高。在竞争风险回归分析中，在调整了 Framingham 的 CVD 风险评分、CVD 存在、SGA、透析状态、高敏 C 反应蛋白、白蛋白、LBMI 和在冰箱中保存的样本时间后，低 IGF-1+低 HGS 与全因死亡率风险增加 2.8 倍相关，而低 IGF-1+高 HGS 则没有相关性。
在 HGS 也较低的患者中，低 IGF-1 与全因死亡率增加相关，但在 HGS 较高的患者中则没有相关性，这表明 IGF-1 与 CKD 患者的生存相关性取决于营养状况。
