Department of Infectious Disease Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
J Cachexia Sarcopenia Muscle. 2023 Feb;14(1):17-29. doi: 10.1002/jcsm.13130. Epub 2022 Nov 20.
The prevalence of sarcopenia and its clinical predictors and clinical impact vary among kidney transplant recipients (KTRs), in part because of different diagnostic criteria. This study aimed to assess the reported diagnosis criteria of sarcopenia and compare them in terms of prevalence, clinical predictors, and impact of sarcopenia. The Medline, Embase, and Cochrane Library were searched for the full-length reports published until 28 January 2022. The subgroup analysis, meta-regression, and sensitivity analysis were performed and heterogeneity was assessed using the I . A total of 681 studies were retrieved, among which only 23 studies (including 2535 subjects, 59.7% men, mean age 49.8 years) were eventually included in the final analysis. The pooled prevalence in these included studies was 26% [95% confidence interval (95% CI): 20-34%, I = 93.45%], including 22% (95% CI: 14-32%, I = 88.76%) in men and 27% (95% CI: 14-41%, I = 90.56%) in women (P = 0.554 between subgroups). The prevalence of sarcopenia diagnosed using low muscle mass was 34% (95% CI: 21-48%, I = 95.28%), and the prevalence of using low muscle mass in combination with low muscle strength and/or low physical performance was 21% (95% CI: 15-28%, I = 90.37%) (P = 0.08 between subgroups). In meta-regression analyses, the mean age (regression coefficient: 1.001, 95% CI: 0.991-1.011) and percentage male (regression coefficient: 0.846, 95% CI: 0.367-1.950) could not predict the effect size. Lower body mass index (odds ratio (OR): 0.57, 95% CI: 0.39-0.84, I = 61.5%), female sex (OR: 0.31, 95% CI: 0.16-0.61, I = 0.0%), and higher age (OR: 1.08, 95% CI: 1.05-1.10, I = 10.1%) were significantly associated with a higher risk for sarcopenia in KTRs, but phase angle (OR: 0.81, 95% CI: 0.16-4.26, I = 84.5%) was not associated with sarcopenia in KTRs. Sarcopenia was not associated with rejections (risk ratio (RR): 0.67, 95% CI: 0.23-1.92, I = 12.1%), infections (RR: 1.03, 95% CI: 0.34-3.12, I = 87.4%), delayed graft functions (RR: 0.81, 95% CI: 0.46-1.43, I = 0.0%), and death (RR: 0.95, 95% CI: 0.32-2.82, I = 0.0%) in KRTs. Sarcopenia was found to be very common in KRTs. However, we have not found that sarcopenia had a negative impact on clinical health after kidney transplantation. Large study cohorts and multicentre longitudinal studies in the future are urgently needed to explore the prevalence and prognosis of sarcopenia in kidney transplant patients.
肌肉减少症的患病率及其临床预测因素和临床影响在肾移植受者（KTRs）中存在差异，部分原因是由于不同的诊断标准。本研究旨在评估肌肉减少症的报告诊断标准，并比较其在患病率、临床预测因素和肌肉减少症影响方面的差异。通过 Medline、Embase 和 Cochrane Library 检索了截至 2022 年 1 月 28 日发表的全文报告。进行了亚组分析、荟萃回归和敏感性分析，并使用 I 评估了异质性。共检索到 681 项研究，其中仅有 23 项研究（包括 2535 名受试者，59.7%为男性，平均年龄 49.8 岁）最终纳入最终分析。这些纳入研究的汇总患病率为 26%[95%置信区间（95%CI）：20-34%，I=93.45%]，其中男性为 22%（95%CI：14-32%，I=88.76%），女性为 27%（95%CI：14-41%，I=90.56%）（亚组间 P=0.554）。使用低肌肉量诊断肌肉减少症的患病率为 34%（95%CI：21-48%，I=95.28%），使用低肌肉量结合低肌肉力量和/或低身体表现的患病率为 21%（95%CI：15-28%，I=90.37%）（亚组间 P=0.08）。在荟萃回归分析中，平均年龄（回归系数：1.001，95%CI：0.991-1.011）和男性百分比（回归系数：0.846，95%CI：0.367-1.950）不能预测效应大小。较低的身体质量指数（比值比（OR）：0.57，95%CI：0.39-0.84，I=61.5%）、女性（OR：0.31，95%CI：0.16-0.61，I=0.0%）和较高的年龄（OR：1.08，95%CI：1.05-1.10，I=10.1%）与 KTRs 中肌肉减少症的风险增加显著相关，但相位角（OR：0.81，95%CI：0.16-4.26，I=84.5%）与 KTRs 中肌肉减少症无关。肌肉减少症与排斥反应（风险比（RR）：0.67，95%CI：0.23-1.92，I=12.1%）、感染（RR：1.03，95%CI：0.34-3.12，I=87.4%）、延迟移植物功能（RR：0.81，95%CI：0.46-1.43，I=0.0%）和死亡（RR：0.95，95%CI：0.32-2.82，I=0.0%）无关。在 KTRs 中，肌肉减少症非常常见。然而，我们还没有发现肌肉减少症对肾移植后患者的临床健康有负面影响。未来需要进行大型队列研究和多中心纵向研究，以探讨肾移植患者肌肉减少症的患病率和预后。
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