Course of Health Science, Hyogo Medical University Graduate School of Health Science, Kobe, Japan.
Department of Physical Therapy, School of Rehabilitation, Hyogo Medical University, Kobe, Japan.
Clin Nutr ESPEN. 2024 Oct;63:651-658. doi: 10.1016/j.clnesp.2024.07.1059. Epub 2024 Aug 2.
Sarcopenia and undernutrition are crucial in the cycle of frailty in patients requiring hemodialysis therapy, and their deleterious clinical consequences are well documented. However, little attention has been directed towards examining their combined impact on clinical outcomes.
This study aimed to elucidate the effects of concomitant sarcopenia and undernutrition on clinical outcomes in patients undergoing hemodialysis.
This prospective cohort study recruited outpatients undergoing hemodialysis from four facilities. Sarcopenia was diagnosed according to the criteria of the Asian Working Group for Sarcopenia, 2019. Undernutrition was determined using the Geriatric Nutritional Risk Index, with a score of <92 classified as undernutrition. Patients were classified into four groups according to the presence or absence of sarcopenia and undernutrition. Cox proportional hazards analysis was used to assess the independent association between concomitant sarcopenia and undernutrition, all-cause mortality, and cardiovascular (CV) events after adjusting for baseline characteristics.
We included 450 patients in this analysis. Of the 450 patients, 69 (15.3%) had concomitant sarcopenia and undernutrition. The mean follow-up period was 1067 days, and there were 61 deaths and 60 CV events. The cumulative survival rate was significantly lower in the sarcopenia with undernutrition group (P = 0.011). The overlap of sarcopenia and undernutrition was significantly associated with a risk of mortality (hazard ratio 2.10; 95% confidence interval 1.05-4.21; P = 0.037). However, no association was observed between the co-occurrence of sarcopenia and undernutrition and the risk of CV events.
Concomitant sarcopenia and undernutrition were significantly associated with an increased mortality risk among patients undergoing hemodialysis. This finding reaffirms the importance of managing sarcopenia and undernutrition in patients undergoing hemodialysis in daily clinical practice.
肌肉减少症和营养不良在需要血液透析治疗的患者的虚弱循环中至关重要，其有害的临床后果已有充分记录。然而，很少有人关注检查它们对临床结果的综合影响。
本研究旨在阐明同时存在肌肉减少症和营养不良对接受血液透析患者临床结局的影响。
这项前瞻性队列研究招募了来自四家机构的接受血液透析的门诊患者。根据 2019 年亚洲肌肉减少症工作组的标准诊断肌肉减少症。使用老年营养风险指数确定营养不良，评分<92 定义为营养不良。根据是否存在肌肉减少症和营养不良，将患者分为四组。使用 Cox 比例风险分析评估同时存在肌肉减少症和营养不良与全因死亡率和心血管（CV）事件之间的独立关联，调整基线特征后。
我们对 450 名患者进行了分析。在这 450 名患者中，有 69 名（15.3%）同时存在肌肉减少症和营养不良。平均随访时间为 1067 天，有 61 例死亡和 60 例 CV 事件。肌肉减少症和营养不良组的累积生存率显著降低（P=0.011）。肌肉减少症和营养不良的重叠与死亡率风险显著相关（风险比 2.10；95%置信区间 1.05-4.21；P=0.037）。然而，未观察到肌肉减少症和营养不良的同时发生与 CV 事件的风险之间存在关联。
同时存在肌肉减少症和营养不良与接受血液透析的患者的死亡率风险增加显著相关。这一发现再次证实了在日常临床实践中管理接受血液透析的患者的肌肉减少症和营养不良的重要性。
