Application Of Dual Energy X-ray Bone Absorptionmetry In The Patients With Chronic Kidney Disease Complicated With Sarcopenia

?Objective?To research the relationship between chronic kidney disease(CKD)and sarcopenia,and to explore the value of dual-energy X-ray absorptiometry in CKD with sarcopenia.?Materials and Methods?One hundred and eighty objects were enrolled in this study including 123 patients with CKD who were treated in the Department of Nephrology and Endocrinology from September 2017 to September 2018,and 57 healthy volunteers from our Health Examination Center were selected to be the blank control.The stage of CKD were defined based on the recommendation of the American kidney disease foundation expert group.The single-photon emission computed tomography(SPECT)was applied to detect the glomerular filtration rate(GFR)of the patients with CKD,who were divided into two groups according to the value of GFR:group CKD1(patients in the 1 and 2 stage of CKD)and group CKD2(patients in the 3-5 stage of CKD).Then,the patients with CKD were divided into two groups according to the value of eGFR converted by the formula of CKD-EPI:group CKD1e(patients in the 1 and 2 stage of CKD)and group CKD2e(patients in the 3 and 5 stage of CKD).In this paper,CKD was analyzed by total GFR obtained by SPECT.The definition of the sacopenia came from the diagnostic criteria of Asian Working Group for Sacopenia(AWGS).The preliminary screening for the sarcopenia was based on the recommendation of Chinese Medical Association Osteoporosis and Bone Minerals Diseases Branch in 2016.The objects were divided into sacopenia group and non-sacopenia group.General clinical data and the results of the laboratory tests and the physical examination were recorded.The bone mineral density in all areas of the body and the body composition were detected by dual-energy X-ray absorptiometry,then the relative appendicular skeletal muscle index(RASMI)would be calculated.The muscular strength of the patients were evaluated by the pinch meter(US JAMAR).Walking speed within 6 metres was apllied to the assessment of muscular function.P<0.05 was defined as significant difference.?Results?1.Relationship between RASMI value and renal function:GFR is the important index of renal function based on renal dynamic imaging,divided into CKD1 group(55cases)?CKD2 group(68 cases),the RASMI value of CKD1 group measured by DXA was 5.59±0.79kg/m2.the RASMI value of the CKD2 group is 5.06±0.80 kg/m2.The values of RASMI in the patients were found to be significantly decreased with the decrease of GFR and the progress of CKD.the difference was statistically significant(Z=-3.253,P=0.001)2.The morbidity of the sarcopenia:19.3%of patients with the sarcopenia were observed in 57 healthy volunteers,the incidence rate of sarcopenia was 40.0%in the patients with group CKD1,and the rate increased to 55.9%in the patients with group CKD2.however,55.7%of the male and 41.9%of the female patients with CKD were diagnosed as the sarcopenia,but the difference was not statistically significant(P=0.162).Chi square test revealed that there was significantly difference in the morbidity of the sarcopenia between the subjects from the control group and the patients of the group CKD 1(?~2=5.772,P=0.016),and significant difference was discovered in the incidence rate of sarcopenia between the subjects from the healthy volunteers and the patients of the group CKD2(?~2=17.413,P=0.000).However there was no significantly difference between the patients of the group CKD1 and CKD2(?~2=3.070,P=0.080).3.The comparison of bone mineral density in different parts of the body between the healthy volunteers and patients with CKD:T test show that the bone density was significantly different between the patients in the healthy volunteers and group CKD2 in the domain of lumbar vertebrae(H=2.663,P=0.023),the hip(H=2.787,P=0.016)and the femoral neck(H=3.716,P=0.001).There was a significant difference between the CKD1group and the CKD2 group(H=2.041,P=0.0041).4.Comparison of bone mineral density between the CKD patients with or without sarcopenia:the bone mineral density between the patients from the two groups were found to be significantly different in the domain of the lumbar and hip and femoral neck(Z=2.179,P=0.029;Z=1.975,P=0.048;Z=2.574,P=0.01).The morbidity of osteoporosis was 41.7%in the sarcopenia group and 20.6%in the non-sarcopenia group.The difference was statistically significant(?2=6.367,P=0.012).?Conclusions?1.The detection of RASMI and bone mineral density in patients with CKD by DXAhas important clinical value in investigating the relationship between renal function and RASMI and bone mineral density.2.The morbidity of the sarcopenia in patients with CKD was higher than the healthyvolunteers,and the incidence rate of the sarcopenia increased as the progression of CKD.Male patients with CKD are more susceptible to the sarcopenia comparing with female patients,but the difference was not statistically significant.3.Kidney dynamic imaging was recommended to accurately assess the renal function of the patients with CKD and the sarcopenia.4.The bone mineral density of all parts in patients will decreased with the progression of CKD,and the bone mineral density in patients of sarcopenia was lower than that of non-sarcopenia in all patients with CKD,and osteoporosis was more likely to occur in patients with CKD.