Department of Nephrology, Ningbo NO.2 Hospital, Ningbo, Zhejiang, China.
Sci Rep. 2024 Jul 23;14(1):16926. doi: 10.1038/s41598-024-65130-0.
Data regarding the association of sarcopenia with hospitalization has led to inconclusive results in patients undergoing dialysis. The main goal of this research was to investigate the association between sarcopenia and hospitalization in Chinese individuals on continuous ambulatory peritoneal dialysis (CAPD). Eligible patients on CAPD were prospectively included, and followed up for 48 weeks in our PD center. Sarcopenia was identified utilizing the criteria set by the Asian Working Group on Sarcopenia in 2019 (AWGS 2019). Participants were categorized into sarcopenia (non-severe sarcopenia + severe sarcopenia) and non-sarcopenia groups. The primary outcome was all-cause hospitalization during the 48-week follow-up period. Association of sarcopenia with all-cause hospitalization was examined by employing multivariate logistic regression models. The risk of cumulative incidence of hospitalization in the 48-week follow-up was estimated using relative risk (RR and 95% CI). The cumulative hospitalization time and frequency at the end of 48-week follow-up were described as categorical variables, and compared by χ test or fisher's exact test as appropriate. Subgroup and sensitivity analyses were also conducted to examine whether the potential association between sarcopenia and hospitalization was modified. A total of 220 patients on CAPD (5 of whom were lost in follow-up) were included. Prevalences of total sarcopenia and severe sarcopenia were 54.1% (119/220) and 28.2% (62/220) according to AWGS 2019, respectively. A total of 113 (51.4%) participants were hospitalized during the 48-week follow-up period, of which, the sarcopenia group was 65.5% (78/119) and the non-sarcopenia group was 34.7% (35/101), with an estimated RR of 1.90 (95%CI 1.43-2.52). The cumulative hospitalization time and frequency between sarcopenia and non-sarcopenia groups were significantly different (both P < 0.001). Participants with sarcopenia (OR = 3.21, 95%CI 1.75-5.87, P < 0.001), non-severe sarcopenia (OR = 2.84, 95%CI 1.39-5.82, P = 0.004), and severe sarcopenia (OR = 3.66, 95%CI 1.68-8.00, P = 0.001) demonstrated a significant association with all-cause hospitalization compared to individuals in non-sarcopenia group in the 48-week follow-up. Moreover, participants in subgroups (male or female; < 60 or ≥ 60 years) diagnosed with sarcopenia, as per AWGS 2019, were at considerably high risk for hospitalization compared to those with non-sarcopenia. In sensitivity analyses, excluding participants lost in the follow-up, the relationships between sarcopenia and hospitalization (sarcopenia vs. non-sarcopenia; severe sarcopenia/non-severe sarcopenia vs. non-sarcopenia) were consistent. This research involving Chinese patients on CAPD demonstrated a significant association between sarcopenia and incident hospitalization, thereby emphasizing the importance of monitoring sarcopenia health in this population.
数据显示，肌肉减少症与透析患者的住院情况相关，但结果并不一致。本研究的主要目的是探讨中国持续性非卧床腹膜透析（CAPD）患者中肌肉减少症与住院之间的关系。符合条件的 CAPD 患者前瞻性纳入本研究，并在我们的 PD 中心进行了 48 周的随访。使用 2019 年亚洲肌肉减少症工作组（AWGS 2019）制定的标准来确定肌肉减少症。将参与者分为肌肉减少症（非严重肌肉减少症+严重肌肉减少症）和非肌肉减少症组。主要结局是在 48 周随访期间的全因住院情况。采用多变量逻辑回归模型来检验肌肉减少症与全因住院之间的关联。使用相对风险（RR 和 95%CI）来估计 48 周随访期间的累积住院风险。在 48 周随访结束时，将累积住院时间和频率描述为分类变量，并根据 χ2 检验或 fisher 确切检验进行比较，具体取决于适用情况。还进行了亚组和敏感性分析，以检查肌肉减少症与住院之间的潜在关联是否存在修饰。共纳入 220 名 CAPD 患者（其中 5 名在随访中丢失）。根据 AWGS 2019，总的肌肉减少症和严重肌肉减少症的患病率分别为 54.1%（119/220）和 28.2%（62/220）。共有 113 名（51.4%）参与者在 48 周随访期间住院，其中肌肉减少症组为 65.5%（78/119），非肌肉减少症组为 34.7%（35/101），估计 RR 为 1.90（95%CI 1.43-2.52）。肌肉减少症组和非肌肉减少症组之间的累积住院时间和频率有显著差异（均 P<0.001）。肌肉减少症（OR=3.21，95%CI 1.75-5.87，P<0.001）、非严重肌肉减少症（OR=2.84，95%CI 1.39-5.82，P=0.004）和严重肌肉减少症（OR=3.66，95%CI 1.68-8.00，P=0.001）与非肌肉减少症组相比，在 48 周随访期间与全因住院显著相关。此外，根据 AWGS 2019，在亚组（男性或女性；<60 岁或≥60 岁）中诊断为肌肉减少症的参与者与非肌肉减少症者相比，住院风险明显更高。在敏感性分析中，排除随访中丢失的参与者，肌肉减少症与住院（肌肉减少症与非肌肉减少症；严重肌肉减少症/非严重肌肉减少症与非肌肉减少症）之间的关系仍然一致。本研究涉及中国 CAPD 患者，结果表明肌肉减少症与住院事件显著相关，因此强调了在该人群中监测肌肉减少症健康状况的重要性。
