Analysis of influencing factors of muscle loss in patients undergoing maintenance hemodialysis_West China Medical Journal

Authors：

DAI Tingting ¹ , ZENG Xiaoqing ² , LIU Yuan ² , GONG Jie ¹ , ZHOU Li ³ , CHENG Yi ² , CHEN Lin ⁴ ,  HU Wen ^1,2

1. West China School of Public Health / West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
4. Hemodialysis Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

HU Wen, Email: wendy_nutrition@163.com

Keywords：

Hemodialysis; Muscle loss; Bioelectric impedance; Body composition; Influencing factors

DOI：

10.7507/1002-0179.201912065

Video：

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Objective To study the differences in body composition between maintenance hemodialysis (MHD) patients with reduced muscle mass and the ones with normal muscle mass by bioelectrical impedance analysis, and explore the influencing factors.Methods A total of 122 patients undergoing MHD in the hemodialysis center of a general hospital between September 2018 and May 2019 were selected as the research subjects. According to the relative skeletal muscle mass index, they were divided into the muscle loss group and the normal muscle mass group. Their general conditions, post-dialysis body composition, and serum albumin were collected to analyze the differences between the two groups, and a multiple stepwise logistic regression analysis was carried out.Results Among the included subjects, 53 patients had normal muscle mass and 69 patients had muscle mass loss. The post-dialysis body weight, muscle-related indexes, intracellular water, extracellular water (ECW), total body water (TBW), protein, minerals, body cell mass, bone mineral content, body mass index, arm circumference, and arm muscle circumference in the normal muscle mass group were higher than those in the muscle loss group (P<0.05); the percentage of ECW/TBW in the normal muscle mass group was lower than that in the muscle loss group (P<0.05). The multiple stepwise logistic regression analysis showed that the post-dialysis weight [odds ratio (OR)=0.679, 95% confidence interval (CI) (0.535, 0.862), P=0.001] was a protective factor from losing muscle in MHD patients, and the high ECW/TBW [OR=6.926, 95%CI (1.014, 47.280), P=0.048], low body cell mass [OR=57.707, 95%CI (6.927, 480.761), P<0.001], low bone mineral content [OR=9.743, 95%CI (1.220, 77.831, P=0.032], and arm circumference [OR=2.183, 95%CI (1.004, 4.749), P=0.049] were risk factors for muscle loss in MHD patients.Conclusions MHD patients have a high incidence of muscle loss. It is necessary to monitor the changes of their body composition, especially those who with low post-dialysis body weight, lack of bone minerals and body cells, excessive ECW/TBW, and increased arm circumference after hemodialysis. Both nutritional interventions and exercise interventions should be performed timely and routinely to prevent the occurrence of sarcopenia.

Citation： DAI Tingting, ZENG Xiaoqing, LIU Yuan, GONG Jie, ZHOU Li, CHENG Yi, CHEN Lin, HU Wen. Analysis of influencing factors of muscle loss in patients undergoing maintenance hemodialysis. West China Medical Journal, 2020, 35(4): 489-493. doi: 10.7507/1002-0179.201912065 Copy

1.	Rymarz A, Gibinska J, Zajbt M, et al. Low lean tissue mass can be a predictor of one-year survival in hemodialysis patients. Ren Fail, 2018, 40(1): 231-237.
2.	Battaglia Y, Galeano D, Cojocaru E, et al. Muscle-wasting in end stage renal disease in dialysis treatment: a review. G Ital Nefrol, 2016, 33(2): gin/33.2.7.
3.	劉丹, 張紅梅, 范汝艷, 等. 維持性血液透析患者肌肉減少癥調查及影響因素分析. 中國中西醫結合腎病雜志, 2018, 19(4): 329-332.
4.	Bataille S, Serveaux M, Carreno E, et al. The diagnosis of sarcopenia is mainly driven by muscle mass in hemodialysis patients. Clin Nutr, 2017, 36(6): 1654-1660.
5.	Chen LK, Liu LK, Woo J, et al. Sarcopenia in Asia: consensus report of the Asian working group for sarcopenia. J Am Med Dir Assoc, 2014, 15(2): 95-101.
6.	Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet, 2012, 379(9818): 815-822.
7.	王婷立, 柳園, 胡雯, 等. 應用生物電阻抗法評估44例維持性血液透析患者的營養狀況. 中國血液凈化, 2015, 14(11): 640-643.
8.	Lamarca F, Carrero JJ, Rodrigues J, et al. Prevalence of sarcopenia in elderly maintenance hemodialysis patients: the impact of different diagnostic criteria. J Nutr Health Aging, 2014, 18(7): 710-717.
9.	Fouque D, Kalantar-Zadeh K, Kopple J, et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int, 2008, 73(4): 391-398.
10.	Chang TI, Ngo V, Streja E, et al. Association of body weight changes with mortality in incident hemodialysis patients. Nephrol Dial Transplant, 2016, 32(9): 1549-1558.
11.	Chazot C, Patrik D, Anne-Lise B, et al. Target weight gain during the first year of hemodialysis therapy is associated with patient survival. Nephron Clin Pract, 2014, 126(3): 128-134.
12.	林華, 謝忠建, 朱梅, 等. 肌肉和骨骼的相互調節. 中華骨質疏松和骨礦鹽疾病雜志, 2016, 9(3): 236-239.
13.	張倫, 朱佳妮, 張振宇, 等. 維持性血液透析病人透析前后體成分變化及影響因素的研究. 全科護理, 2019, 17(14): 1738-1740.
14.	許汝福. Logistic回歸變量篩選及回歸方法選擇實例分析. 中國循證醫學雜志, 2016, 16(11): 1360-1364.
15.	曾小慶, 柳園, 程懿, 等. 不同年齡、性別血液透析患者體成分及營養狀況分析. 現代預防醫學, 2018, 45(6): 1141-1144.

1. Rymarz A, Gibinska J, Zajbt M, et al. Low lean tissue mass can be a predictor of one-year survival in hemodialysis patients. Ren Fail, 2018, 40(1): 231-237.
2. Battaglia Y, Galeano D, Cojocaru E, et al. Muscle-wasting in end stage renal disease in dialysis treatment: a review. G Ital Nefrol, 2016, 33(2): gin/33.2.7.
3. 劉丹, 張紅梅, 范汝艷, 等. 維持性血液透析患者肌肉減少癥調查及影響因素分析. 中國中西醫結合腎病雜志, 2018, 19(4): 329-332.
4. Bataille S, Serveaux M, Carreno E, et al. The diagnosis of sarcopenia is mainly driven by muscle mass in hemodialysis patients. Clin Nutr, 2017, 36(6): 1654-1660.
5. Chen LK, Liu LK, Woo J, et al. Sarcopenia in Asia: consensus report of the Asian working group for sarcopenia. J Am Med Dir Assoc, 2014, 15(2): 95-101.
6. Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet, 2012, 379(9818): 815-822.
7. 王婷立, 柳園, 胡雯, 等. 應用生物電阻抗法評估44例維持性血液透析患者的營養狀況. 中國血液凈化, 2015, 14(11): 640-643.
8. Lamarca F, Carrero JJ, Rodrigues J, et al. Prevalence of sarcopenia in elderly maintenance hemodialysis patients: the impact of different diagnostic criteria. J Nutr Health Aging, 2014, 18(7): 710-717.
9. Fouque D, Kalantar-Zadeh K, Kopple J, et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int, 2008, 73(4): 391-398.
10. Chang TI, Ngo V, Streja E, et al. Association of body weight changes with mortality in incident hemodialysis patients. Nephrol Dial Transplant, 2016, 32(9): 1549-1558.
11. Chazot C, Patrik D, Anne-Lise B, et al. Target weight gain during the first year of hemodialysis therapy is associated with patient survival. Nephron Clin Pract, 2014, 126(3): 128-134.
12. 林華, 謝忠建, 朱梅, 等. 肌肉和骨骼的相互調節. 中華骨質疏松和骨礦鹽疾病雜志, 2016, 9(3): 236-239.
13. 張倫, 朱佳妮, 張振宇, 等. 維持性血液透析病人透析前后體成分變化及影響因素的研究. 全科護理, 2019, 17(14): 1738-1740.
14. 許汝福. Logistic回歸變量篩選及回歸方法選擇實例分析. 中國循證醫學雜志, 2016, 16(11): 1360-1364.
15. 曾小慶, 柳園, 程懿, 等. 不同年齡、性別血液透析患者體成分及營養狀況分析. 現代預防醫學, 2018, 45(6): 1141-1144.

West China Medical Journal

Analysis of influencing factors of muscle loss in patients undergoing maintenance hemodialysis

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