Antoine Chatrenet, Pierre-Yves de Müllenheim, Massimo Torreggiani, Julia Nava Hernández, Rocío Urbina Arronte, Abril Gutiérrez Espinoza, Giorgina Barbara Piccoli
{"title":"质量问题:一项观察性研究:慢性肾脏疾病进展与肌肉力量减少相关,独立于骨骼肌质量的变化。","authors":"Antoine Chatrenet, Pierre-Yves de Müllenheim, Massimo Torreggiani, Julia Nava Hernández, Rocío Urbina Arronte, Abril Gutiérrez Espinoza, Giorgina Barbara Piccoli","doi":"10.1093/ckj/sfaf036","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is commonly associated with multifactorial neuromuscular impairments. Few studies have investigated CKD-induced changes in maximal voluntary force (MVF), and even fewer have longitudinal follow-up. The aim of this study is to investigate whether CKD progression modifies the relationship between skeletal muscle mass and force, and the prevalence of sarcopaenia and sarcopenic obesity.</p><p><strong>Methods: </strong>The data used were prospectively collected during routine check-ups in a network of nutritional centres in Mexico and retrospectively analysed. From a dataset of 5430 patients, we selected 1098 patients with available anthropometric, kidney function, handgrip and bioimpedance data. The relationship between appendicular skeletal muscle mass (ASM) and MVF was investigated using mixed models and adjusted for age, sex, body mass index, physical activity level and CKD aetiology. Sarcopaenia prevalence were tested across period of follow-up using the Cochran-Mantel-Haenzen for repeated measures and across CKD stages using the Chi-2 test.</p><p><strong>Results: </strong>After normalization with ASM, MVF was higher in CKD G1-G3 compared with G4 and G5 (<i>P</i> ≤ .001, Cohen's d = 0.270-0.576). Slopes between MVF and ASM were lower in CKD G3, G4 and G5 than in CKD G1-G2 [-2.268 (-3.927, -0.609), <i>P</i> <i> </i>= .008; -2.694 (-4.593, -0.794), <i>P</i> <i> </i>= .006; -3.675 (-5.326, -1.725), <i>P</i> <i> </i>< .001, respectively]. The prevalence of sarcopaenia and sarcopaenic obesity did not differ across CKD stages, but recovery was most commonly observed in CKD G1-G2. Slope analysis showed an independent interaction between the slopes of kidney function and ASM on MVF evolution over time.</p><p><strong>Conclusions: </strong>CKD negatively, progressively and independently affects the neuromuscular system, and force production is reduced for any given muscle mass as CKD progresses. While no association was found between CKD stage and prevalence of sarcopaenia, recovery was more frequent in the early CKD stages. These results suggest the importance of early rehabilitation programs to improve musculoskeletal health, quality of life and survival in CKD patients.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf036"},"PeriodicalIF":3.9000,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883232/pdf/","citationCount":"0","resultStr":"{\"title\":\"Quality matters: chronic kidney disease progression is associated with reduced muscle strength independently of changes in skeletal muscle mass: an observational study.\",\"authors\":\"Antoine Chatrenet, Pierre-Yves de Müllenheim, Massimo Torreggiani, Julia Nava Hernández, Rocío Urbina Arronte, Abril Gutiérrez Espinoza, Giorgina Barbara Piccoli\",\"doi\":\"10.1093/ckj/sfaf036\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Chronic kidney disease (CKD) is commonly associated with multifactorial neuromuscular impairments. Few studies have investigated CKD-induced changes in maximal voluntary force (MVF), and even fewer have longitudinal follow-up. The aim of this study is to investigate whether CKD progression modifies the relationship between skeletal muscle mass and force, and the prevalence of sarcopaenia and sarcopenic obesity.</p><p><strong>Methods: </strong>The data used were prospectively collected during routine check-ups in a network of nutritional centres in Mexico and retrospectively analysed. From a dataset of 5430 patients, we selected 1098 patients with available anthropometric, kidney function, handgrip and bioimpedance data. The relationship between appendicular skeletal muscle mass (ASM) and MVF was investigated using mixed models and adjusted for age, sex, body mass index, physical activity level and CKD aetiology. Sarcopaenia prevalence were tested across period of follow-up using the Cochran-Mantel-Haenzen for repeated measures and across CKD stages using the Chi-2 test.</p><p><strong>Results: </strong>After normalization with ASM, MVF was higher in CKD G1-G3 compared with G4 and G5 (<i>P</i> ≤ .001, Cohen's d = 0.270-0.576). Slopes between MVF and ASM were lower in CKD G3, G4 and G5 than in CKD G1-G2 [-2.268 (-3.927, -0.609), <i>P</i> <i> </i>= .008; -2.694 (-4.593, -0.794), <i>P</i> <i> </i>= .006; -3.675 (-5.326, -1.725), <i>P</i> <i> </i>< .001, respectively]. The prevalence of sarcopaenia and sarcopaenic obesity did not differ across CKD stages, but recovery was most commonly observed in CKD G1-G2. Slope analysis showed an independent interaction between the slopes of kidney function and ASM on MVF evolution over time.</p><p><strong>Conclusions: </strong>CKD negatively, progressively and independently affects the neuromuscular system, and force production is reduced for any given muscle mass as CKD progresses. While no association was found between CKD stage and prevalence of sarcopaenia, recovery was more frequent in the early CKD stages. These results suggest the importance of early rehabilitation programs to improve musculoskeletal health, quality of life and survival in CKD patients.</p>\",\"PeriodicalId\":10435,\"journal\":{\"name\":\"Clinical Kidney Journal\",\"volume\":\"18 3\",\"pages\":\"sfaf036\"},\"PeriodicalIF\":3.9000,\"publicationDate\":\"2025-02-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883232/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Kidney Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ckj/sfaf036\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/3/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Kidney Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ckj/sfaf036","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:慢性肾脏疾病(CKD)通常与多因素神经肌肉损伤相关。很少有研究调查ckd引起的最大自主力(MVF)的变化,更少有纵向随访。本研究的目的是调查CKD进展是否改变骨骼肌质量和力量之间的关系,以及肌少症和肌少性肥胖的患病率。方法:所使用的数据是在墨西哥营养中心网络的常规检查期间前瞻性收集的,并进行回顾性分析。从5430例患者的数据集中,我们选择了1098例具有可用人体测量、肾功能、握力和生物阻抗数据的患者。采用混合模型研究阑尾骨骼肌质量(ASM)与MVF之间的关系,并根据年龄、性别、体重指数、体力活动水平和CKD病因进行调整。使用Cochran-Mantel-Haenzen进行重复测量,并使用Chi-2检验在不同的CKD阶段检测肌萎缩症的患病率。结果:ASM归一化后,G1-G3组的MVF高于G4、G5组(P≤0.001,Cohen’s d = 0.270 ~ 0.576)。CKD G3、G4和G5组MVF和ASM的斜率低于CKD G1-G2组[-2.268 (-3.927,-0.609),P = 0.008;-2.694 (-4.593, -0.794), p = 0.006;结论:CKD对神经肌肉系统有负性的、进行性的、独立的影响,随着CKD的进展,任何肌肉量的产力都会减少。虽然没有发现CKD分期与肌少症患病率之间的关联,但在早期CKD阶段恢复更为频繁。这些结果表明早期康复计划对改善慢性肾病患者的肌肉骨骼健康、生活质量和生存率的重要性。
Quality matters: chronic kidney disease progression is associated with reduced muscle strength independently of changes in skeletal muscle mass: an observational study.
Background: Chronic kidney disease (CKD) is commonly associated with multifactorial neuromuscular impairments. Few studies have investigated CKD-induced changes in maximal voluntary force (MVF), and even fewer have longitudinal follow-up. The aim of this study is to investigate whether CKD progression modifies the relationship between skeletal muscle mass and force, and the prevalence of sarcopaenia and sarcopenic obesity.
Methods: The data used were prospectively collected during routine check-ups in a network of nutritional centres in Mexico and retrospectively analysed. From a dataset of 5430 patients, we selected 1098 patients with available anthropometric, kidney function, handgrip and bioimpedance data. The relationship between appendicular skeletal muscle mass (ASM) and MVF was investigated using mixed models and adjusted for age, sex, body mass index, physical activity level and CKD aetiology. Sarcopaenia prevalence were tested across period of follow-up using the Cochran-Mantel-Haenzen for repeated measures and across CKD stages using the Chi-2 test.
Results: After normalization with ASM, MVF was higher in CKD G1-G3 compared with G4 and G5 (P ≤ .001, Cohen's d = 0.270-0.576). Slopes between MVF and ASM were lower in CKD G3, G4 and G5 than in CKD G1-G2 [-2.268 (-3.927, -0.609), P= .008; -2.694 (-4.593, -0.794), P= .006; -3.675 (-5.326, -1.725), P< .001, respectively]. The prevalence of sarcopaenia and sarcopaenic obesity did not differ across CKD stages, but recovery was most commonly observed in CKD G1-G2. Slope analysis showed an independent interaction between the slopes of kidney function and ASM on MVF evolution over time.
Conclusions: CKD negatively, progressively and independently affects the neuromuscular system, and force production is reduced for any given muscle mass as CKD progresses. While no association was found between CKD stage and prevalence of sarcopaenia, recovery was more frequent in the early CKD stages. These results suggest the importance of early rehabilitation programs to improve musculoskeletal health, quality of life and survival in CKD patients.
期刊介绍:
About the Journal
Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.