Hsu Bang-Gee, Wang Chih-Hsien, Tsai Jen-Pi, Chen Yi-Hsin, Hung Szu-Chun, Lin Yu-Li
Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
Front Med (Lausanne). 2024 Oct 16;11:1487449. doi: 10.3389/fmed.2024.1487449. eCollection 2024.
Sarcopenia is highly prevalent in patients undergoing peritoneal dialysis (PD), contributing to adverse clinical outcomes. Animal models suggest that parathyroid hormone (PTH) induces muscle wasting through adipose tissue browning. However, the relationship between PTH dysregulation and sarcopenia in the PD population remains unclear. Thus, we aimed to explore the association between serum intact PTH levels and sarcopenia in PD patients.
We conducted a cross-sectional analysis using data from the Tzu-Chi PD cohort, comprising 186 PD patients with a mean age of 57.5 ± 14.1 years. Basic information, comorbidities, serum intact PTH levels, and other biochemical data were retrieved. Atherosclerotic cardiovascular disease (ASCVD) includes any history of coronary artery disease, myocardial infarction, peripheral arterial disease, and stroke. All patients were evaluated for appendicular skeletal muscle mass (ASM) using the Body Composition Monitor (BCM), handgrip strength, and 6-m usual gait speed. Sarcopenia was defined based on the consensus of the Asian Working Group for Sarcopenia 2019. Relative over-hydration (OH) was also assessed using BCM.
The overall prevalence of sarcopenia was 38.2%. Across three groups of intact PTH levels (<150 pg/mL, 150-300 pg/mL, and >300 pg/mL), the prevalence rates of sarcopenia were 29.7, 36.4, and 46.2%, respectively ( for trend = 0.044). In the unadjusted model, age, ASCVD, subjective global assessment score, body mass index, relative OH, serum albumin, creatinine, phosphorus, and log-transformed intact PTH levels were significantly associated with sarcopenia. After full adjustment for all above factors, age (odds ratio [OR] = 1.04, 95% confidence interval [CI] = 1.00-1.08), ASCVD (OR = 4.12, 95% CI = 1.34-12.65), BMI (OR = 0.51, 95% CI = 0.41-0.64), relative OH (OR = 1.04, 95% CI = 1.00-1.07), log-transformed intact PTH levels (OR = 3.72, 95% CI = 1.51-9.14) were independently associated sarcopenia among PD patients.
Among PD patients, elevated serum intact PTH levels are independently associated with sarcopenia. Further longitudinal studies are warranted to confirm their causal relationship.
肌肉减少症在接受腹膜透析（PD）的患者中非常普遍，会导致不良临床结局。动物模型表明，甲状旁腺激素（PTH）通过脂肪组织褐变诱导肌肉萎缩。然而，PD患者中PTH失调与肌肉减少症之间的关系仍不清楚。因此，我们旨在探讨PD患者血清完整PTH水平与肌肉减少症之间的关联。
我们使用慈济腹膜透析队列的数据进行了横断面分析，该队列包括186例平均年龄为57.5±14.1岁的PD患者。收集了基本信息、合并症、血清完整PTH水平和其他生化数据。动脉粥样硬化性心血管疾病（ASCVD）包括任何冠心病、心肌梗死、外周动脉疾病和中风病史。所有患者均使用身体成分监测仪（BCM）、握力和6米常规步态速度评估四肢骨骼肌质量（ASM）。根据2019年亚洲肌肉减少症工作组的共识定义肌肉减少症。还使用BCM评估相对水合过度（OH）。
肌肉减少症的总体患病率为38.2%。在完整PTH水平的三组（<150 pg/mL、150 - 300 pg/mL和>300 pg/mL）中，肌肉减少症的患病率分别为29.7%、36.4%和46.2%（趋势P = 0.044）。在未调整模型中，年龄、ASCVD、主观全面评定评分、体重指数、相对OH、血清白蛋白、肌酐、磷和对数转换后的完整PTH水平与肌肉减少症显著相关。在对所有上述因素进行完全调整后，年龄（优势比[OR]=1.04，95%置信区间[CI]=1.00 - 1.08）、ASCVD（OR = 4.12，95% CI = 1.34 - 12.65）、BMI（OR = 0.51，95% CI = 0.41 - 0.64）、相对OH（OR = 1.04，95% CI = 1.00 - 1.07）、对数转换后的完整PTH水平（OR = 3.72，95% CI = 1.51 - 9.14）在PD患者中与肌肉减少症独立相关。
在PD患者中，血清完整PTH水平升高与肌肉减少症独立相关。需要进一步的纵向研究来证实它们之间的因果关系。
