The Study Of Sarcopenia In Peritoneal Dialysis Patients

Objective1.To investigate the prevalence and associated factors of sarcopenia in peritoneal dialysis(PD)patients.2.To explore the longitudinal changes of muscle mass and muscle strength in PD patients and further investigate predictors of their change.3.To investigate the relationship between sarcopenia and all-cause mortality in PD patients.Methods1.Eligible PD patients in Renji Hospital,Shanghai Jiao Tong University School of Medicine from November 2016 to August 2018 were enrolled.Bioelectrical impedance spectroscopy(BIS)was applied to measure the lean tissue mass(LTM).Handgrip strength(HGS)of patients was measured.The prevalence of sarcopenia in PD patients was evaluated.Multivariate logistic regression was used to explore the associated factors of sarcopenia in PD patients.2.Patients who completed data collection at baseline and 48 weeks were included in the study.The longitudinal change of LTM and HGS was observed.Multivariate logistic regression was employed to explore the predictors of changes in LTM and HGS.3.All patients were followed up to death,withdrawal from PD,transferring to other centers,loss of follow-up or the end of the study(January 31,2019).Kaplan-Meier survival curve was used to compare survival of patients with sarcopenia and non-sarcopenia.The Cox proportional hazard model was used to analyze the independent risk factors of all-cause mortality in PD patients.Results1.A total of 224 patients were enrolled in the study with median age of 57.6(44.8,65.7)years and median PD duration of 20.2(6.4,57.6)months.Of them,there were 134 male patients(59.8%)and 48 diabetic patients(21.4%).The prevalence of sarcopenia was 12.9%.Compared to patients in non-sarcopenia group,patients with sarcopenia were older {[63.1(46.7,68.5)] years vs.[57.3(44.0,65.4)] years,P=0.046},presented with longer PD duration {[42.4(7.8,87.1)] months vs.[19.4(6.4,55.3)] months,P=0.014},more prevalent diabetes [13(44.8%)vs.35(17.9%),P=0.001],lower residual renal function(RRF){[0.49(0,2.11)] ml/min vs.[1.45(0,3.63)] ml/min,P=0.049} and serum pre-albumin {[359.0(291.0,383.5)] mg/L vs.390.0(345.0,455.0)mg/L,P=0.003},greater ratio of extracellular water to intracellular water(ECW/ICW){[0.96(0.92,1.11)] vs.[0.90(0.81,0.98)],P<0.001} and high sensitivity C-reactive protein(hsCRP){[3.13(0.91,10.12)] mg/L vs.[1.52(0.56,5.02)] mg/L,P=0.020}.Multivariate logistic analysis showed that the male sex(OR=4.07,95%CI: 1.44-11.51,P=0.008),PD duration(OR=1.01,95%CI: 1.00-1.02,P=0.048)and ECW/ICW(OR=1.09,95%CI: 1.05-1.14,P<0.001)were independently associated with sarcopenia in PD patients.2.A total of 158 patients completed data collection at baseline and 48 weeks.The median age was 58.4(47.2,66.4)years and the median PD duration was 30.6(10.6,66.3)months.Of them,there were 94 male patients(59.5%)and 40 diabetic patients(25.3%).Compared with baseline,LTM {[35.4(29.5,50.6)] kg vs.[36.1(29.6,44.7)] kg,P=0.040} and HGS {[23.9(17.9,31.2)] kg vs.[25.0(18.4,31.6)] kg,P=0.006} decreased significantly at 48 weeks.A decrease in muscle mass and strength were found in 57 patients(36.1%)and 69 patients(43.7%)after 48 weeks,respectively.Age(OR=1.033,95%CI: 1.006-1.061,P=0.019)and normalized protein catabolic rate(nPCR)(OR=0.155,95%CI: 0.025-0.965,P=0.046)were independent predictors of a decrease in muscle mass.Fasting blood glucose(OR=1.258,95%CI: 1.017-1.556,P=0.034)and overhydration(OH)(OR=1.199,95%CI: 1.004-1.431,P=0.045)independently predicted a decrease in muscle strength.3.The median follow-up time was 20.9(12.6,23.6)months.There were 15 patients(6.7%)dead at the end of the study,including 13 cardiovascular events(86.7%)and 2 infections(13.3%).Low HGS,low LTI and sarcopenia had no significant effect on all-cause mortality in PD patients during the follow-up period(all P>0.05).Conclusions1.Sarcopenia was common in PD patients.Male,PD duration and ECW/ICW were independent associated factors of sarcopenia in PD patients.2.A gradual decline was seen in muscle mass and muscle strength of PD patients.Aging and insufficient protein intake might be related with decreased muscle mass.Better glucose and volume control would be beneficial to enhance muscle strength in PD patients.3.There was no association between sarcopenia and all-cause mortality in PD patients after a short-term follow-up.However,further studies with larger sample size and longer follow-up are needed to investigate the relationship between sarcopenia and prognosis in PD patients.