Department of Nephrology, Beijing Jishuitan Hospital, Beijing, China.
Department of Radiology, Beijing Jishuitan Hospital, Beijing, China.
Front Endocrinol (Lausanne). 2023 Mar 23;14:1117438. doi: 10.3389/fendo.2023.1117438. eCollection 2023.
Sarcopenia is highly prevalent (28.5-40.3%) in patients undergoing hemodialysis and leads to poor clinical outcomes. However, the association between muscle quality and sarcopenia in patients receiving hemodialysis remains unclear. Therefore, we aimed to explore the association between muscle cross-sectional area (CSA) and proton-density fat-fraction (PDFF) in patients with sarcopenia undergoing hemodialysis.
Seventy-six patients undergoing hemodialysis for > 3 months were enrolled. Their handgrip strength (HGS), short physical performance battery (SPPB) performance, and appendicular skeletal muscle mass index (ASMI) were measured. Sarcopenia was defined using the Asian Working Group for Sarcopenia 2019 consensus update. All patients underwent quantitative magnetic resonance imaging. CSA and PDFF were measured for the thigh, trunk, and gluteus muscles.
The prevalence of probable, confirmed, and severe sarcopenia in this study was 73.7%, 51.3%, and 22.4%, respectively. Older age (OR: 1.061, < 0.003); lower body mass index (BMI) (OR: 0.837, 0.008), albumin (OR: 0.765, 0.004), prealbumin (OR: 0.987, 0.001), predialysis blood urea nitrogen (BUN) (OR: 0.842, 0.001), predialysis creatinine (OR: 0.993, 0.001), phosphorus (OR: 0.396, 0.047); lower CSA of the thigh (OR: 0.58, 0.035), third lumbar (L3) trunk (OR: 0.37, 0.004), gluteus minimus and medius (OR: 0.28, 0.001), and gluteus maximus (OR: 0.28, 0.001); and higher PDFF of the thigh (OR: 1.89, 0.036) and L3 trunk (OR: 1.71, 0.040) were identified as sarcopenia risk factors. The gluteus minimus and medius CSA was lower in patients with sarcopenia than in those without after adjusting for age and BMI (OR: 0.37, 0.017). Higher thigh ( 0.031) and L3 trunk ( 0.006) muscle PDFF were significantly associated with lower HGS. Furthermore, higher thigh ( = 0.011) and L3 trunk ( = 0.010) muscle PDFF were also inversely correlated with lower ASMI.
Our findings demonstrate the high prevalence of sarcopenia and myosteatosis in patients undergoing hemodialysis and might trigger a paradigm shift in intervention strategies for patients receiving hemodialysis.
肌肉减少症在接受血液透析的患者中发病率很高（28.5%-40.3%），并导致不良的临床结局。然而，接受血液透析患者的肌肉质量与肌肉减少症之间的关系仍不清楚。因此，我们旨在探讨接受血液透析的肌肉减少症患者肌肉横截面积（CSA）与质子密度脂肪分数（PDFF）之间的关系。
纳入了 76 名接受血液透析治疗>3 个月的患者。测量了他们的握力（HGS）、短体适能表现测试（SPPB）表现和四肢骨骼肌质量指数（ASMI）。使用亚洲肌肉减少症工作组 2019 年共识更新定义了肌肉减少症。所有患者均进行了定量磁共振成像。测量了大腿、躯干和臀肌的 CSA 和 PDFF。
本研究中，可能、确诊和严重肌肉减少症的患病率分别为 73.7%、51.3%和 22.4%。年龄较大（OR：1.061，<0.003）；较低的体重指数（BMI）（OR：0.837，<0.008）、白蛋白（OR：0.765，<0.004）、前白蛋白（OR：0.987，<0.001）、透析前血尿素氮（BUN）（OR：0.842，<0.001）、透析前肌酐（OR：0.993，<0.001）、磷（OR：0.396，<0.047）；较低的大腿 CSA（OR：0.58，<0.035）、第三腰椎（L3）躯干 CSA（OR：0.37，<0.004）、臀小肌和臀中肌 CSA（OR：0.28，<0.001）、臀大肌 CSA（OR：0.28，<0.001）；以及较高的大腿 PDFF（OR：1.89，<0.036）和 L3 躯干 PDFF（OR：1.71，<0.040）被确定为肌肉减少症的危险因素。调整年龄和 BMI 后，肌肉减少症患者的臀小肌和臀中肌 CSA 低于无肌肉减少症患者（OR：0.37，<0.017）。较高的大腿（0.031）和 L3 躯干（0.006）肌肉 PDFF 与较低的 HGS 显著相关。此外，较高的大腿（=0.011）和 L3 躯干（=0.010）肌肉 PDFF 也与较低的 ASMI 呈负相关。
我们的研究结果表明，接受血液透析的患者肌肉减少症和肌内脂肪增多症的发病率较高，这可能引发对接受血液透析患者的干预策略的范式转变。
