- 期刊
- OpenAccess
High Muscle Mass is Associated With Better Survival and Probably With Worse Renal Outcome in CKD Stage 4-5 Patients
摘要
BACKGROUND: Muscle wasting is a manifestation of protein-energy wasting (PEW) and is increasing the prevalence as renal function worsening. However, the independent effect of muscle mass to predict the mortality and renal outcomes is still questioned in patients with advanced chronic kidney disease (CKD). So, we use malnutrition-inflammation score (MIS) to evaluate PEW and hypothesize that muscle mass has a role of prediction for all-cause mortality and renal outcomes, even after the consideration of PEW, in CKD stage 4-5 patients. METHODS: We included 744 patients with stage 4-5 CKD. To study the impact of muscle mass on mortality and renal outcomes, the included patients were divided into four muscle mass groups (cutoff: 13.2%, 14.5%, and 15.7% in men; 11.8%, 13.0%, and 14.1% in women). Linear regression analysis was used to evaluate the factors associated with muscle mass. Cox proportional hazards analysis was used to investigate the relationship of muscle mass percentage (MMP%) and lean body mass percentage (LBM%) with all-cause mortality and renal outcomes. RESULTS: We reported the hazard ratio for mortality with the fully adjusted Cox regression model grouped by MMP% with adjustment for malnutrition-inflammation score (MIS). The reference groups were MMP% Q1. Mortality was significantly decreased in MMP% Q2 (HR: 0.51; 95% CI: 0.32-0.83), Q3 (HR: 0.53; 95% CI: 0.31-0.88), and Q4 (HR: 0.41; 95% CI: 0.23-0.73). Renal outcomes were non-significant increase in MMP% Q2 (HR: 0.99; 95% CI: 0.72-1.30), Q3 (HR: 1.00; 95% CI: 0.70-0.50), and Q4 (HR: 1.3; 95% CI: 0.88-1.90). The reference groups were LBM% Q1. Mortality was significantly decreased in LBM% Q2 (HR: 0.51; 95% CI: 0.32-0.83), Q3 (HR: 0.53; 95% CI: 0.31-0.88), and Q4 (HR: 0.41; 95% CI: 0.23-0.73). Renal outcomes were non-significant increase in MMP% Q2 (HR: 0.99; 95% CI: 0.72-1.30), Q3 (HR: 1.00; 95% CI: 0.70-0.50), and Q4 (HR: 1.3; 95% CI: 0.88-1.90). Adjustment for MIS had no effect on the association of MMP% and LBM% with all-cause mortality and renal outcomes. CONCLUSIONS: In our study, we found that muscle mass is associated with better survival and probably with worsened renal outcomes in CKD stage 4-5 patients. Moreover, we elucidate the muscle mass still has the independent prediction function for all-cause mortality and probably renal outcomes after considering protein-energy wasting by MIS.