基于血清肌酐和胱抑素 C 的肌少症指数对非透析依赖性慢性肾脏病患者肾脏结局的影响：来自 KNOW-CKD 研究的结果。

Impact of Serum Creatinine- and Cystatin C-Based Sarcopenia Index on Renal Outcomes in Non-Dialysis-Dependent Chronic Kidney Disease Patients: Results From the KNOW-CKD Study.

机构信息

Division of Nephrology, Department of Internal Medicine, Bucheon St Mary's Hospital, The Catholic University College of Medicine, Seoul, Korea.

Division of Nephrology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

出版信息

Mayo Clin Proc. 2024 Sep;99(9):1388-1398. doi: 10.1016/j.mayocp.2024.03.009. Epub 2024 Aug 6.

DOI:10.1016/j.mayocp.2024.03.009

PMID:39115506

Abstract

OBJECTIVE

To evaluate the impact of the serum creatinine- and cystatin C-based new sarcopenia index (SI) on renal outcomes in non-dialysis-dependent patients with chronic kidney disease (CKD).

METHODS

In this observational Korean Cohort Study for Outcome in Patients With CKD (KNOW-CKD), 1957 patients with CKD stage 1 to stage 4 were analyzed from 2011 to 2019. Men and women were separately assigned to quartile groups according to their SI. The primary outcome was a composite renal outcome consisting of 50% reduction in estimated glomerular filtration rate or end-stage kidney disease. With use of Fine and Gray subdistribution hazard models, the association between the SI and the primary outcome was analyzed.

RESULTS

During a median follow-up of 6.0 (4.2 to 7.7) years, the primary composite renal outcome occurred in 528 (28.6%) patients within a median of 3.0 (1.8 to 5.0) years. In unadjusted and adjusted models, lower SI groups had a poor primary outcome compared with the highest group (quartile 4). The hazard ratios for quartiles 1, 2, and 3 compared with quartile 4 in the fully adjusted model were 4.47 (95% CI, 3.05 to 6.56; P<.001), 3.08 (95% CI, 2.13 to 4.48; P<.001), and 2.09 (95% CI, 1.45 to 3.01; P<.001), respectively. Restricted cubic spline regression analyses found a relatively inverse linear relationship between the SI and the composite renal outcome.

CONCLUSION

The new SI is an independent predictor of renal outcomes. A low SI is associated with poor renal outcome.

摘要

目的

评估基于血清肌酐和胱抑素 C 的新肌少症指数（SI）对非透析依赖性慢性肾脏病（CKD）患者肾脏结局的影响。

方法

本研究采用观察性韩国慢性肾脏病患者结局研究（KNOW-CKD），纳入 2011 年至 2019 年的 1957 例 CKD 1 至 4 期患者。根据 SI 将男性和女性患者分别分配到四分位组。主要结局为包括估算肾小球滤过率降低 50%或终末期肾病在内的复合肾脏结局。采用 Fine 和 Gray 亚分布风险模型分析 SI 与主要结局之间的相关性。

结果

中位随访 6.0（4.2 至 7.7）年期间，中位随访 3.0（1.8 至 5.0）年内，528 例（28.6%）患者发生主要复合肾脏结局。在未调整和调整模型中，与最高四分位组（第 4 四分位组）相比，SI 较低组的主要结局较差。在完全调整模型中，第 1、2 和 3 四分位组与第 4 四分位组相比，风险比分别为 4.47（95%CI，3.05 至 6.56；P<.001）、3.08（95%CI，2.13 至 4.48；P<.001）和 2.09（95%CI，1.45 至 3.01；P<.001）。受限立方样条回归分析发现 SI 与复合肾脏结局之间存在相对的线性反比关系。