Lonardo Maria Serena, Cacciapuoti Nunzia, Chiurazzi Martina, Di Lauro Mariastella, Guida Bruna, Damiano Simona, Cataldi Mauro
Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy.
Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy.
Nutr Metab Cardiovasc Dis. 2023 Nov;33(11):2169-2178. doi: 10.1016/j.numecd.2023.06.015. Epub 2023 Jun 22.
The early identification of undernourished patients with CKD could help instating appropriate nutritional intervention before the full development of the threatening condition known as Protein Energy Wasting (PEW). Handgrip strength (HGS) and blood hemoglobin (Hb) concentration are two parameters considered representative of nutritional status but not included among the criteria for PEW diagnosis. In the present work we investigated whether they could help identifying CKD patients at risk of undernutrition.
We performed a two-step cluster analysis to classify a cohort of 71 stage 3-5 CKD patients, none of which with PEW, according to their Hb concentration and dominant-hand HGS. Two clusters were finely separated using this method. When we compared the two groups for main body composition and nutritional variables by using t-test statistics or Mann-Whitney test, as appropriate, we found significant differences in PhA, ECW/TBW, ASMI, serum iron. Then we stratified our population by gender and performed cluster analysis as well. PhA, ECW/TBW were still significantly different in the two clusters both in M and in F, while serum iron concentration only in males and ASMI only in females.
These results suggest that either in male than in female Hb concentration and HGS may distinguish two subgroups of CKD patients with different nutritional status and disease severity. Patient belonging to either of these cluster can be easily identified by using the HGS/Hb ratio which represents the HGS normalized per gr Hb.
早期识别慢性肾脏病（CKD）营养不良患者有助于在蛋白质能量消耗（PEW）这一威胁性状况全面发展之前实施适当的营养干预。握力（HGS）和血液血红蛋白（Hb）浓度是被认为代表营养状况的两个参数，但未纳入PEW诊断标准之中。在本研究中，我们调查了它们是否有助于识别有营养不良风险的CKD患者。
我们进行了两步聚类分析，根据Hb浓度和优势手握力对71例3 - 5期CKD患者（均无PEW）进行分类。使用该方法可将两个聚类清晰分开。当我们使用t检验统计或适当的曼 - 惠特尼检验比较两组的主要身体成分和营养变量时，我们发现相位角（PhA）、细胞外液/总体液（ECW/TBW）、去脂体重指数（ASMI）、血清铁存在显著差异。然后我们按性别对人群进行分层并进行聚类分析。在男性和女性中，两个聚类的PhA、ECW/TBW仍存在显著差异，而血清铁浓度仅在男性中存在差异，ASMI仅在女性中存在差异。
这些结果表明，无论是男性还是女性，Hb浓度和HGS都可能区分出营养状况和疾病严重程度不同的两个CKD患者亚组。通过使用代表每克Hb标准化后的HGS的HGS/Hb比值，可以轻松识别属于这两个聚类中的任何一个聚类的患者。
