营养状况与常染色体显性多囊肾病患者的肾功能保留相关。
Nutritional Status is Associated With Preserved Kidney Function in Patients With Autosomal Dominant Polycystic Kidney Disease.
机构信息
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
Department of Internal Medicine, Hallym University College of Medicine, Seoul, South Korea.
出版信息
J Ren Nutr. 2023 Jul;33(4):529-537. doi: 10.1053/j.jrn.2023.02.006. Epub 2023 Mar 24.
OBJECTIVE
Malnutrition is a common complication in autosomal dominant polycystic kidney disease (ADPKD). We examined whether nutritional status is associated with the preservation of kidney function, using a cohort of typical ADPKD.
METHODS
We enrolled ambulatory ADPKD patients in 9 tertiary medical centers in Korea from May 2019 to December 2021. We excluded patients who were aged less than 18 years, who had known end-stage kidney disease at the time of enrollment, who had a diagnosis of atypical ADPKD, and who were Tolvaptan users. The primary outcome was an estimated glomerular filtration rate (eGFR) decline >3 mL/min/1.73 m, based on nutritional status assessed by subjective global assessment (SGA). We also evaluated an eGFR decline >1 mL/min/1.73 m, an increase in urine protein-creatinine ratio (UPCR) > 0, and an increase in UPCR >0.3 as secondary outcomes, based on SGA after the 1-year follow-up. A logistic regression (LR) model was used to calculate the odds ratio (OR) for the primary outcome. Because there were differences in several baseline variables, such as Mayo classification, serum hemoglobin, serum creatinine, and UPCR between SGA groups, we matched propensity scores.
RESULTS
In total, 805 patients were prospectively enrolled. Among them, 236 patients who had 1-year follow-up data and typical imaging findings were analyzed to evaluate the effect of nutritional status on kidney function. SGA was used to assess the nutritional status. The mean age was 45.0 ± 13.3 years, and 49.6% of the patients were female. The mean eGFR was 81.9 mL/min/1.73 m. Among the 236 patients, 91 (38.6%) experienced a 1-year eGFR decline >3 mL/min/1.73 m. When a multivariable LR was applied, SGA 3-6 was identified as a significant factor related to a 1-year eGFR decline >3 mL/min/1.73 m (adjusted OR = 1.22 [1.04-1.43]; P = .017). Despite matching propensity scores, the 1-year eGFR decline >3 mL/min/1.73 m was still higher in the SGA 3-6 group regardless of proteinuria.
CONCLUSION
Good nutritional status is associated with better-preserved kidney function in non-obese typical ADPKD patients who do not take Tolvaptan.
目的
营养不良是常染色体显性多囊肾病（ADPKD）的常见并发症。我们通过一组典型的 ADPKD 患者来研究营养状况是否与肾功能的保留有关。
方法
我们从 2019 年 5 月至 2021 年 12 月在韩国的 9 个三级医疗中心招募了门诊 ADPKD 患者。我们排除了年龄小于 18 岁、入组时已患有终末期肾病、诊断为非典型 ADPKD 以及使用托伐普坦的患者。主要结局是根据主观整体评估（SGA）评估的营养状况，估计肾小球滤过率（eGFR）下降>3 mL/min/1.73 m。我们还根据 SGA 评估了 1 年后的次要结局，包括 eGFR 下降>1 mL/min/1.73 m、尿蛋白/肌酐比（UPCR）增加>0.0 和 UPCR 增加>0.3。使用逻辑回归（LR）模型计算主要结局的优势比（OR）。由于 SGA 组之间存在几个基线变量（如 Mayo 分类、血清血红蛋白、血清肌酐和 UPCR）的差异，我们进行了倾向评分匹配。
结果
总共前瞻性纳入了 805 名患者。其中，236 名患者具有 1 年随访数据和典型影像学表现，用于评估营养状况对肾功能的影响。使用 SGA 评估营养状况。患者的平均年龄为 45.0±13.3 岁，49.6%为女性。平均 eGFR 为 81.9 mL/min/1.73 m。在 236 名患者中，91 名（38.6%）在 1 年内 eGFR 下降>3 mL/min/1.73 m。当应用多变量 LR 时，SGA 3-6 被确定为与 1 年内 eGFR 下降>3 mL/min/1.73 m 相关的显著因素（调整后的 OR=1.22[1.04-1.43]；P=0.017）。尽管进行了倾向评分匹配，但无论蛋白尿如何，SGA 3-6 组的 1 年内 eGFR 下降>3 mL/min/1.73 m 仍然更高。
结论
在不服用托伐普坦的非肥胖典型 ADPKD 患者中，良好的营养状况与更好的肾功能保留有关。
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