Abstract：
BACKGROUND: Protein-energy wasting in hemodialysis (HD) patients is characterized by decreased skeletal muscle mass and plasma protein. Some previous studies reported relationships between skeletal muscle dysfunction and iron deficiency. Dialysis patients with malnutrition may have a functional iron deficiency (FID) because of inflammation. Serum total iron binding capacity (TIBC), correlated with transferrin, is a nutritional status marker in HD patients and a biomarker of iron status. The relationship between muscle loss and iron status is unknown. The aim of the present study was to assess the relationship between iron status and change in skeletal muscle mass.
METHODS: A prospective cohort of 267 HD patients was examined for 12 months. Blood samples were obtained at baseline to measure TIBC, ferritin, transferrin saturation (TSAT), and hepcidin-25. Nutritional status and changes in muscle mass were assessed by subjective global assessment, albumin, creatinine index, and percentage creatinine generation rate.
RESULTS: At baseline, lower tertiles of TIBC were significantly related to lower muscle mass and albumin levels; they were also significantly correlated with high ferritin, hepcidin-25, and TSAT levels, as well as a higher proportion of use of erythropoiesis-stimulating agents. Multiple regression analysis adjusted with confounders showed TIBC was an independent biomarker for decreased muscle mass and albumin. Change in muscle mass remained significantly decreased in the lower tertile of TIBC and in malnourished patients.
CONCLUSIONS: The present study demonstrated relationships between FID and muscle loss. TIBC was an independent biomarker of muscle loss in HD patients, considering iron status, inflammation, oxidative stress, and malnutrition.
METHODS: A prospective cohort of 267 HD patients was examined for 12 months. Blood samples were obtained at baseline to measure TIBC, ferritin, transferrin saturation (TSAT), and hepcidin-25. Nutritional status and changes in muscle mass were assessed by subjective global assessment, albumin, creatinine index, and percentage creatinine generation rate.
RESULTS: At baseline, lower tertiles of TIBC were significantly related to lower muscle mass and albumin levels; they were also significantly correlated with high ferritin, hepcidin-25, and TSAT levels, as well as a higher proportion of use of erythropoiesis-stimulating agents. Multiple regression analysis adjusted with confounders showed TIBC was an independent biomarker for decreased muscle mass and albumin. Change in muscle mass remained significantly decreased in the lower tertile of TIBC and in malnourished patients.
CONCLUSIONS: The present study demonstrated relationships between FID and muscle loss. TIBC was an independent biomarker of muscle loss in HD patients, considering iron status, inflammation, oxidative stress, and malnutrition.
摘要：
背景：血液透析（HD）患者的蛋白质能量消耗以骨骼肌质量和血浆蛋白减少为特征。以前的一些研究报道了骨骼肌功能障碍与铁缺乏之间的关系。营养不良的透析患者可能由于炎症而患有功能性铁缺乏症（FID）。血清总铁结合力（TIBC），与转铁蛋白相关，是HD患者的营养状况标志物和铁状态的生物标志物。肌肉损失与铁状态之间的关系尚不清楚。本研究的目的是评估铁状态与骨骼肌质量变化之间的关系。
方法：对267例HD患者进行了为期12个月的前瞻性队列研究。在基线时获取血样以测量TIBC，铁蛋白,转铁蛋白饱和度（TSAT），和铁调素-25。营养状况和肌肉质量的变化通过主观整体评估来评估，白蛋白,肌酐指数,和肌酐生成率百分比。
结果：在基线时，TIBC的低三位数与较低的肌肉质量和白蛋白水平显着相关；它们也与高铁蛋白显着相关，铁调素-25和TSAT水平，以及使用红细胞生成刺激剂的比例更高。校正混杂因素的多元回归分析显示，TIBC是肌肉质量和白蛋白降低的独立生物标志物。在TIBC的下三分位数和营养不良的患者中，肌肉质量的变化仍然显着降低。
结论：本研究证明了FID与肌肉损失之间的关系。TIBC是HD患者肌肉损失的独立生物标志物，考虑到铁的地位，炎症,氧化应激，和营养不良。
方法：对267例HD患者进行了为期12个月的前瞻性队列研究。在基线时获取血样以测量TIBC，铁蛋白,转铁蛋白饱和度（TSAT），和铁调素-25。营养状况和肌肉质量的变化通过主观整体评估来评估，白蛋白,肌酐指数,和肌酐生成率百分比。
结果：在基线时，TIBC的低三位数与较低的肌肉质量和白蛋白水平显着相关；它们也与高铁蛋白显着相关，铁调素-25和TSAT水平，以及使用红细胞生成刺激剂的比例更高。校正混杂因素的多元回归分析显示，TIBC是肌肉质量和白蛋白降低的独立生物标志物。在TIBC的下三分位数和营养不良的患者中，肌肉质量的变化仍然显着降低。
结论：本研究证明了FID与肌肉损失之间的关系。TIBC是HD患者肌肉损失的独立生物标志物，考虑到铁的地位，炎症,氧化应激，和营养不良。
