Li Jin'e, Tu Hua, Zhang Yuying, Yang Shiqi, Yu Peng, Liu Jianping
Department of Endocrinology and Metabolism, Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
J Cachexia Sarcopenia Muscle. 2025 Jun;16(3):e13828. doi: 10.1002/jcsm.13828.
The relationship between obesity, sarcopenic obesity and all-cause mortality in chronic kidney disease (CKD) patients remains controversial. This study aims to investigate the role of low muscle mass and fat mass in the risk of all-cause mortality in CKD patients in the United States.
This study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999-2006 and 2011-2018, including 1553 adults with CKD. Multivariable Cox proportional hazards models were constructed to explore the relationship between sarcopenia, fat mass and all-cause mortality, with nonlinear relationships assessed using restricted cubic splines. Subgroup analyses were conducted based on sex, CKD stages and the presence of sarcopenia.
The average age of participants was 58.15 ± 18.48 years, with 45% being male. Sarcopenia was more common in men, non-diabetic individuals and those with lower education levels. During a median follow-up of 119.5 months, 693 deaths from all causes were recorded. After adjusting for multiple variables, sarcopenia was significantly associated with increased all-cause mortality risk in CKD patients (HR 1.21; 95% CI 1.00-1.45, p = 0.047). Participants were categorized based on body mass index (BMI) into normal (reference), sarcopenia only, obesity only and sarcopenic obesity groups. Results showed that obesity alone had a protective effect in CKD Stages I-II (HR 0.45, 95% CI 0.28-0.72, p = 0.001) whereas it had an opposite effect in CKD Stages III-V (CKD III: HR 1.67, 95% CI 1.07-2.60, p = 0.024; CKD IV-V: HR 17.51, 95% CI 1.29-238.01, p = 0.032). Further analysis of fat mass data revealed that compared with the lowest quartile (Q1), middle and higher quartiles of fat mass showed significant benefits in male participants (Q2: HR 0.71, 95% CI 0.51-0.99, p = 0.046; Q3: HR 0.62, 95% CI 0.41-0.92, p = 0.019) and those in CKD Stage III (Q2: HR 0.64, 95% CI 0.47-0.88, p = 0.006; Q3: HR 0.62, 95% CI 0.41-0.93, p = 0.021).
In this longitudinal cohort study, we found that sarcopenia was associated with an increased risk of all-cause mortality in CKD patients, whereas moderate or higher fat mass might mitigate this risk, particularly in male patients. Prognostic management for CKD patients should focus on increasing muscle mass rather than simply reducing body weight.
肥胖、肌少症性肥胖与慢性肾脏病（CKD）患者全因死亡率之间的关系仍存在争议。本研究旨在调查低肌肉量和脂肪量在美国CKD患者全因死亡风险中的作用。
本研究利用了1999 - 2006年和2011 - 2018年期间进行的美国国家健康与营养检查调查（NHANES）的数据，其中包括1553名成年CKD患者。构建多变量Cox比例风险模型以探讨肌少症、脂肪量与全因死亡率之间的关系，并使用受限立方样条评估非线性关系。根据性别、CKD分期和肌少症的存在情况进行亚组分析。
参与者的平均年龄为58.15±18.48岁，其中45%为男性。肌少症在男性、非糖尿病个体和教育水平较低的人群中更为常见。在中位随访119.5个月期间，记录了693例全因死亡。在调整多个变量后，肌少症与CKD患者全因死亡风险增加显著相关（风险比[HR] 1.21；95%置信区间[CI] 1.00 - 1.45，p = 0.047）。参与者根据体重指数（BMI）分为正常（参照）、仅肌少症、仅肥胖和肌少症性肥胖组。结果显示，单纯肥胖在CKD I - II期具有保护作用（HR 0.45，95% CI 0.28 - 0.72，p = 0.001），而在CKD III - V期则具有相反作用（CKD III期：HR 1.67，95% CI 1.07 - 2.60，p = 0.024；CKD IV - V期：HR 17.51，95% CI 1.29 - 238.01，p = 0.032）。对脂肪量数据的进一步分析显示，与最低四分位数（Q1）相比，脂肪量处于中间和较高四分位数的男性参与者（Q2：HR 0.71，95% CI 0.51 - 0.99，p = 0.046；Q3：HR 0.62，95% CI 0.41 - 0.92，p = 0.019）以及CKD III期患者（Q2：HR 0.64，95% CI 0.47 - 0.88，p = 0.006；Q3：HR 0.62，95% CI 0.41 - 0.93，p = 0.021）显示出显著益处。
在这项纵向队列研究中，我们发现肌少症与CKD患者全因死亡风险增加相关，而中等或更高的脂肪量可能会减轻这种风险，尤其是在男性患者中。CKD患者的预后管理应侧重于增加肌肉量，而不是简单地减轻体重。
