Wang Meiqiu, Chen Zijian, Yu Tingting, You Lianghui, Peng Yingchao, Chen Huangyu, Zhang Pei, Shi Zhuo, Fang Xiang, Jia LiLi, Xia Zhengkun, Ji Chenbo, Tang Hao, Gao Chunlin
Department of Pediatrics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Department of Radiology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
J Ren Nutr. 2025 Mar;35(2):281-288. doi: 10.1053/j.jrn.2024.11.003. Epub 2024 Nov 15.
Skeletal muscle loss and abnormal fat distribution are predictors of poor clinical outcomes in adults with chronic kidney disease (CKD). However, the relationship between body composition (muscle mass and adipose tissue) and prognosis in children with CKD has not been well elucidated.
The retrospective single-center study enrolled children with CKD and healthy group who underwent an abdominal computerized tomography examination and compared the body composition of the third lumbar spine (L3) between the 2 groups. We defined the primary outcome as hemodialysis, peritoneal dialysis, kidney transplantation, or death. Logistic regression analysis was applied to assess the connection between low skeletal muscle density (SMD) and clinical and demographic variables. Multivariate Cox regression analysis was used to evaluate the risk factors for progression to the primary outcome. Kaplan-Meier survival analysis was performed to compare the effect of different body composition on event-free survival rate.
Thirty-two patients with CKD [estimated glomerular filtration rate: 14.89 (8.86, 29.88) (mL/min/1.73 m)] and 66 heathy subjects [estimated glomerular filtration rate: 135.72 (121.70, 161.29) (mL/min/1.73 m)] were recruited in our study. From the assessment of body composition assessed by computerized tomography, skeletal muscle area, SMD, and skeletal muscle index in the CKD group was lower than those in the healthy group (P < .05). On the other hand, visceral fat area and visceral fat index in the CKD group were significantly higher than those in the healthy group (P < .05). In logistic regression analysis, triglyceride (odds ratio: 8.635, 95% confidence interval (CI): 1.153-64.687) was independently associated with low SMD. After adjusting clinical data and body composition, high serum albumin (hazard ratio: 0.873, 95% CI: 0.798-0.955) and high SMD (hazard ratio: 0.895, 95% CI: 0.822-0.974) were protective factors for delaying renal failure. Based on the Kaplan-Meier analysis, only the group with low SMD had lower event-free survival in comparison to the reference group (P < .05).
These findings suggest that there is significant skeletal muscle loss and decrease in SMD in CKD children. Notably, low SMD is indicative of poor prognosis in CKD children.
骨骼肌丢失和脂肪分布异常是慢性肾脏病（CKD）成人患者临床预后不良的预测指标。然而，CKD儿童的身体组成（肌肉质量和脂肪组织）与预后之间的关系尚未得到充分阐明。
这项回顾性单中心研究纳入了接受腹部计算机断层扫描检查的CKD儿童和健康组儿童，并比较了两组第三腰椎（L3）的身体组成。我们将主要结局定义为血液透析、腹膜透析、肾移植或死亡。应用逻辑回归分析评估低骨骼肌密度（SMD）与临床及人口统计学变量之间的关联。多变量Cox回归分析用于评估进展至主要结局的危险因素。进行Kaplan-Meier生存分析以比较不同身体组成对无事件生存率的影响。
本研究纳入了32例CKD患者[估计肾小球滤过率：14.89（8.86，29.88）（mL/min/1.73m²）]和66例健康受试者[估计肾小球滤过率：135.72（121.70，161.29）（mL/min/1.73m²）]。通过计算机断层扫描评估身体组成发现，CKD组的骨骼肌面积、SMD和骨骼肌指数均低于健康组（P<.05）。另一方面，CKD组的内脏脂肪面积和内脏脂肪指数显著高于健康组（P<.05）。在逻辑回归分析中，甘油三酯（比值比：8.635，95%置信区间（CI）：1.153-64.687）与低SMD独立相关。在调整临床数据和身体组成后，高血清白蛋白（风险比：0.873，95%CI：0.798-0.955）和高SMD（风险比：0.895，95%CI：0.822-0.974）是延缓肾衰竭的保护因素。基于Kaplan-Meier分析，与参照组相比，只有低SMD组的无事件生存率较低（P<.05）。
这些发现表明，CKD儿童存在显著的骨骼肌丢失和SMD降低。值得注意的是，低SMD表明CKD儿童预后不良。
