Low skeletal muscle mass by computerized tomography is associated with increased mortality risk in end-stage kidney disease patients on hemodialysis

被引:20
作者
Sabatino, Alice [1 ,2 ]
Regolisti, Giuseppe [1 ,2 ,3 ]
Benigno, Giuseppe [1 ,2 ]
Di Mario, Francesca [1 ,2 ]
Avesani, Carla Maria [4 ]
Fiaccadori, Enrico [1 ,2 ]
机构
[1] Azienda Osped Univ Parma, UO Nefrol, Via Gramsci 14, I-43100 Parma, Italy
[2] Univ Parma, Dipartimento Med & Chirurg, Parma, Italy
[3] Azienda Osped Univ Parma, UO Clin & Immunol Med, Parma, Italy
[4] Karolinska Inst, Dept Clin Sci Technol & Intervent, Div Renal Med & Baxter Novum, Stockholm, Sweden
关键词
Computed tomography; End-stage kidney disease; Muscle wasting; Mortality; Sarcopenia; QUALITY-OF-LIFE; BODY-COMPOSITION; SARCOPENIA; NUTRITION; HEALTH; CIRCUMFERENCE; POPULATION; PREVALENCE; CONSENSUS; SURVIVAL;
D O I
10.1007/s40620-021-01167-y
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background and aims Skeletal muscle (SM) area, as measured by abdominal CT at the level of the third lumbar vertebra (L3), has been proposed as a proxy of whole body muscle mass. However, population-specific reference values are lacking. In the present study we aimed at: (1) detecting low SM area on abdominal CT images in patients on hemodialysis by applying cut-offs derived from a group of healthy subjects, and (2) estimating the independent risk of all-cause mortality associated with low SM area. Methods We retrospectively enrolled 212 adult patients on hemodialysis, undergoing abdominal CT scan (study group), and 87 healthy kidney donors (reference group). We obtained the gender-specific 5th percentile values of the abdominal SM area distribution from both the whole control group and the subgroup of younger (29-60 years) subjects, which we used as reference cut-offs. Then we applied those cut-offs in the study group to identify patients with low SM area. We used survival and Cox regression analysis to evaluate the risk of all-cause mortality associated with low abdominal SM area. Results In the fully adjusted Cox regression analysis, the patients with low abdominal SM area had a higher risk of death than the patients with values above the reference cut-off derived in the subgroup of younger controls (adjHR = 1.79 (1.21; 2.67), P = 0.004). Conclusions Abdominal CT imaging can be used to detect low abdominal SM area in patients on hemodialysis by applying cut-offs derived from healthy subjects sharing a similar ethnic background. Low SM area as assessed by CT is independently associated with all-cause mortality in ESKD patients on hemodialysis.
引用
收藏
页码:545 / 557
页数:13
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