Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Berlin, Germany.
Department of Rehabilitation Medicine, School of Medicine, Yokohama City University, Yokohama, Japan.
J Cachexia Sarcopenia Muscle. 2023 Aug;14(4):1589-1595. doi: 10.1002/jcsm.13260. Epub 2023 May 24.
Cachexia, in the form of unintentional weight loss >5% in 12 months or less, and secondary sarcopenia in the form of muscle wasting are serious conditions that affect clinical outcomes. A chronic disease state such as chronic kidney disease (CKD) often contributes to these wasting disorders. The purpose of this review is to summarize the prevalence of cachexia and sarcopenia, their relationship with kidney function, and indicators for evaluating kidney function in patients with CKD. It is estimated that approximately half of all persons with CKD will develop cachexia with an estimated annual mortality rate of 20%, but few studies have been conducted on cachexia in CKD. Hence, the true prevalence of cachexia in CKD and its effects on kidney function and patient outcomes remain unclear. Some studies have highlighted the concept of protein-energy wasting (PEW) which usually include sarcopenia and cachexia. Several studies have examined kidney function and CKD progression in patients with sarcopenia. Most studies use serum creatinine levels to estimate kidney function. However, creatinine may be influenced by muscle mass, and creatinine-based glomerular filtration rate may overestimate kidney function in patients with reduced muscle mass or muscle wasting. Cystatin C, which is least affected by muscle mass, has been used in some studies, and creatinine-to-cystatin-C ratio has emerged as an important prognostic marker. A previous study incorporating 428 320 participants reported that participants with CKD and sarcopenia had a 33% higher hazard of mortality compared with those without (7% to 66%, P = 0.011), and that those with sarcopenia were twice as likely to develop end-stage kidney disease (hazard ratio: 1.98; 1.45 to 2.70, P < 0.001). Future studies on cachexia and sarcopenia in patients with CKD are needed to report rigorously defined cachexia concerning kidney function. Moreover, in studies on sarcopenia with CKD, it is desirable to accumulate studies using cystatin C to accurately estimate kidney function.
恶病质，表现为 12 个月内非故意体重下降 >5%，以及继发性肌肉减少症导致的肌肉消耗，是影响临床结局的严重情况。慢性疾病状态，如慢性肾脏病 (CKD)，常导致这些消耗性疾病。本综述的目的是总结恶病质和肌肉减少症的患病率，它们与肾功能的关系，以及评估 CKD 患者肾功能的指标。据估计，大约一半的 CKD 患者会出现恶病质，年死亡率估计为 20%，但很少有研究关注 CKD 中的恶病质。因此，CKD 中恶病质的真实患病率及其对肾功能和患者结局的影响仍不清楚。一些研究强调了蛋白质-能量消耗 (PEW) 的概念，该概念通常包括肌肉减少症和恶病质。一些研究检查了肌肉减少症患者的肾功能和 CKD 进展。大多数研究使用血清肌酐水平来估计肾功能。然而，肌酐可能受肌肉量影响，在肌肉量减少或肌肉消耗的患者中，基于肌酐的肾小球滤过率可能高估肾功能。胱抑素 C 受肌肉量影响最小，已在一些研究中使用，肌酐与胱抑素 C 比值已成为一个重要的预后标志物。一项纳入 428320 名参与者的先前研究报告称，患有 CKD 和肌肉减少症的参与者的死亡率比没有这些疾病的参与者高 33%（7%至 66%，P=0.011），且这些肌肉减少症患者发生终末期肾病的可能性是前者的两倍（风险比：1.98；1.45 至 2.70，P<0.001）。需要进一步研究 CKD 患者中的恶病质和肌肉减少症，以严格报告与肾功能相关的恶病质。此外，在研究 CKD 与肌肉减少症时，最好使用胱抑素 C 来准确估计肾功能，积累更多的相关研究。
